Introduction Standardised postoperative care pathways (SPCP) allow the introduction of a targeted goal-directed approach to recovery following major cancer surgery. A standardised oesophagectomy clinical pathway was established at Virginia Mason Medical Center (VMMC), Seattle, USA in 1991 and has undergone five revisions up to 2011. No information exists as to whether pathways can be successfully relocated between different cancer programs and health systems. In March 2011 a multidiscliplinary team from the Royal Surrey County Hospital (RSC) visited VMMC and instituted a similar pathway in April 2011. The aim of this study is to determine the effect of the translocation and implementation of an oesophagectomy care pathway on postoperative outcomes within a 1 year time period.
Methods Four groups were included in this study:
74 patients operated on at VMMC (2009–2011).
12 RSC patients operated on before the introduction of SPCP.
12 RSC patients operated on after the introduction of SPCP but not included.
12 RSC patients managed according to the SPCP.
Groups were compared with respect to patient demographics, peri- and post-operative outcomes.
Results Presenting demographics were similar in all groups with respect to BMI, medical co-morbidities, ASA grade and clinical stage. Age was significantly reduced Group 4 compared to Group 2 (p<0.05). Following initiating SPCP the use of feeding jejunostomies increased (67%–100%; p<0.05) as did immediate extubation (67%–100%; p<0.05). Further statistically significant improvements were noted in complications, length of ICU and hospital stay. Group 3 also showed a less significant improvement in length of ICU and hospital stay, and first day mobilisation.
Conclusion The results of this study demonstrate the potential for accelerated improvement in short-term outcomes following oesophagectomy through the translocation and integration of standardised postoperative pathways. SPCP can also change hospital processes to improve outcomes in other patients. A multidisciplinary approach with involvement of the entire health care team in the design, implementation, evaluation and revision of these pathways is essential and will help ensure all team members are committed to achieving specific targeted pathway goals.
Competing interests None declared.
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