A clinical pathway for postoperative management and early patient discharge: does it work in gynecologic oncology?
This study was presented at the 24th Annual Resident Paper Day, University of California Irvine Medical Center, Orange, CA, May 21, 2007.
Received 9 October 2007; received in revised form 17 January 2008; accepted 17 April 2008. published online 03 June 2008.
Objective
This study evaluates a postoperative clinical pathway among gynecologic oncology patients.
Study Design
880 surgical admissions were retrospectively reviewed at an institution which used a clinical pathway consisting of early feeding and ambulation as well as prompt discontinuation of intravenous fluids with conversion to oral analgesics. Readmission, mortality, and complication rates were calculated. Patient proportions were compared by using the χ2, Mann-Whitney, and t tests.
Results
40% of the surgeries were radical and/or staging procedures and 100% underwent open laparotomies. The median length of hospital stay was 2 days. Only 5% required readmission. The median time to readmission was 4 days. Those patients with a longer initial length of hospital stay and higher mean blood loss were more likely to be readmitted (P < .01). The most common diagnosis was endometrial carcinoma (n = 188). This subgroup also had a median length of hospital stay of 2 days and the readmission rate was 3.6%. The perioperative mortality rate was low in the group as a whole with only 1 death (0.2%). There were no reoperations for hemoperitoneum or urinary or intestinal fistulas.
Conclusion
This management approach resulted in a length of hospital stay of 2 days without increasing morbidity or mortality after laparotomy for suspected gynecologic malignancy.
aDivision of Gynecologic Oncology, Chao Family Comprehensive Cancer Center, University of California Irvine Medical Center, Orange, CA
bDepartment of Obstetrics and Gynecology, University of California Irvine, Orange, and the Department of Gynecologic Oncology, Kaiser Permanente, Orange County, Orange, CA
Reprints not available from the authors.
Cite this article as: Chase DM, Lopez S, Nguyen CN, et al. A clinical pathway for postoperative management and early patient discharge, does it work in gynecologic oncology? Am J Obstet Gynecol 2008;199:541.e1-541.e7.
ABSTRACT
A clinical pathway for postoperative management and early patient discharge: does it work in gynecologic oncology?