Association of surgical care practices with length of stay and use of clinical protocols after elective bowel resection: results of a national survey

• Published in: The American journal of surgery Vol. 199; no. 3; pp. 299 - 304
• Main Authors: Delaney, Conor P., M.D., M.Ch., Ph.D, Senagore, Anthony J., M.D., M.B.A., M.S, Gerkin, Todd M., M.D, Beard, Timothy L., M.D, Zingaro, Wendy M., M.P.A, Tomaszewski, Kenneth J., Ph.D., M.S, Walton, Laura K, Poston, Sara A., Pharm.D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2010; Elsevier Limited
• Subjects: Abdomen; Abdominal surgery; Avoidance; Bowel resection; Clinical outcomes; Clinical pathway; Clinical Protocols; Colorectal Surgery; Critical Pathways; Data recovery; Demographics; Elective Surgical Procedures; Enhanced recovery pathway; Female; General Surgery; Hospital costs; Hospitals; Humans; Intestinal Diseases - surgery; Intestine; Laparoscopy; Length of Stay - statistics & numerical data; Male; Medical personnel; Middle Aged; Narcotics; Nutrition research; Opioids; Ostomy; Pain; Patients; Perioperative care; Postoperative Care; Postoperative ileus; Postoperative period; Practice Patterns, Physicians; Studies; Surgeons; Surgery; Surgical outcomes; Teaching hospitals; Variables; World Wide Web; United States > US; Bowel resection; Clinical pathway; Postoperative ileus; Perioperative care; Enhanced recovery pathway
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2009.08.027

Abstract Background Although management techniques have been proposed to accelerate gastrointestinal recovery after elective bowel resection (BR), most data are derived from single-institution experience. This study assessed the current state of perioperative care for elective BRs and the effect of pathway components on length of stay. Methods A web-based survey was conducted among surgeons regarding their last elective BR. Results Among 207 general and 200 colorectal surgeons, 30% practice in hospitals with a perioperative surgical care pathway intended to accelerate gastrointestinal recovery. Pathway components included early ambulation, early diet progression, early nasogastric tube removal/avoidance, and opioid-sparing pain control. Care practices associated with decreased length of stay included laparoscopic technique, early mobilization, early liquids, and antiemetic use to prevent symptoms associated with prolonged postoperative ileus. Conclusions Few hospitals have pathways but most surgeons likely would implement nationally endorsed guidelines. These data, along with other studies, may lead to well-accepted BR care pathways.