Review

Clinical and Organizational Content of Clinical Pathways for Digestive Surgery: A Systematic Review
L. Lemmens^a, R. van Zelm^c, I. Borel Rinkes^b, R. van Hillegersberg^b, H. Kerkkamp^d

Departments of
^aPerioperative and Emergency Care, and
^bSurgery, University Medical Center Utrecht, Utrecht,
^cQ-Consult Business Consultants, Arnhem, and
^dAtrium Medical Center, Heerlen, The Netherlands

Address of Corresponding Author

Dig Surg 2009;26:91-99 (DOI: 10.1159/000206142)

  Key Words

• Digestive tract surgery, outcome
• Gastrointestinal cancer
• Digestive surgery, clinical pathways

  Abstract

Background/Aims: Oncology surgery of the gastrointestinal tract is complex and infamous for its high complication rates. One of the methods for implementing interventions to optimize the patients' condition and to enhance postoperative outcome is the development and implementation of a clinical pathway. The aim of this study was to analyze the content, i.e. the interventions of clinical pathways for digestive surgery and their effects on postoperative outcome measures. Methods: We performed a systematic review to study clinical pathways in hospital care for adult patients undergoing elective surgery of the stomach, esophagus, pancreas, liver, colon or rectum. The MEDLINE, EMBASE and CINAHL literature databases were searched. Results: The most common interventions in the clinical pathways in this review were defined in the pre- and postoperative phase and included: nutritional management, pain management, mobilization, education and discharge planning. The primary aim of these interventions was to enhance postoperative recovery. Conclusion: Clinical pathways for digestive surgery contain specific interventions to improve postoperative outcome. Most of these interventions are in accordance with the Enhanced Recovery After Surgery (ERAS) protocol, which is an evidence-based protocol for care after colon resections. They result in reduced length of stay without compromising other postoperative outcome measures.

Copyright © 2009 S. Karger AG, Basel

  Author Contacts

Mrs. L.C. Lemmens, PhD
Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, PO Box 1
NL-3720 BA Bilthoven (The Netherlands)
Tel. +31 30 274 4016, Fax +31 30 274 4407, E-Mail lidwien.lemmens@rivm.nl

  Article Information

Published online: March 2, 2009
Number of Print Pages : 9
Number of Figures : 1, Number of Tables : 2, Number of References : 44