Ann Surg Treat Res.  2015 Jun;88(6):311-317. 10.4174/astr.2015.88.6.311.

Analysis of patient-dropouts from the critical pathways for gastric cancer

• Kim S
• Yoo YS
• Kim JH
• Min YD

• KMID: 1800644
• DOI: http://doi.org/10.4174/astr.2015.88.6.311

Abstract

PURPOSE
This study was designed to determine the factors affecting completion of critical pathway for elective gastrectomy.
METHODS
Since 2008, a critical pathway has been applied for elective gastrectomy at Chosun University Hospital. We retrospectively analyzed 252 patients who underwent elective gastrectomies from January 2009 to April 2013. The completion rate was determined, and risk factors for patient dropout were examined.
RESULTS
The completion rate of the critical pathway was 45.6% (115/252). Mean length of stay was 11.7 +/- 8.6 days (8-59 days). Readmission rates were 4.4% (11/252). Causes of failure for clinical pathway were systemic complications (21/137, 15.3%), intra-abdominal complications (44/137, 32.8%), patient factors (41/137, 29.9%), and wound complications (30/137, 21.9%). There were no significant differences between the two groups in age, sex, American Society of Anesthesiologists (ASA) score, operation time, readmission, and underlying disease (P > 0.05). Body mass index (P = 0.008) and pathologic stage (P = 0.001) were significantly different between the two groups. In multivariate analysis, the conventional approach (odds ratio, 2.0), and total gastrectomy (odds ratio, 5.3) were determined to be independent risk factors to drop the critical pathway. But there were no significant differences between total and distal gastrectomy groups in age, gender, underlying diseases, ASA score, readmission, operation time, and cause of dropout (P > 0.05).
CONCLUSION
We concluded that total gastrectomy may not be suitable for the critical pathway. We suggest that the critical pathway for elective distal gastrectomy is divided 2 subgroups, according to the surgical approach.

Keyword

Gastrectomy; Critical pathways; Stomach neoplasms

MeSH Terms

Body Mass Index
Critical Pathways*
Gastrectomy
Humans
Length of Stay
Multivariate Analysis
Patient Dropouts
Retrospective Studies
Risk Factors
Stomach Neoplasms*
Wounds and Injuries

Figure

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  Fig. 1 Critical pathway for elective gastrectomy. Preop., preoperative; Postop., postoperative; POD, postoperative day; NPO, non per os; OR, operating room; PRN, pro re nata; UGI, upper gastrointestinography; TG, total gastrectomy.

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