title: Beneficial impact of a clinical care pathway in patients with testicular cancer undergoing retroperitoneal lymph node dissection.
abstract: OBJECTIVE
  Since 1997, we have used a clinical collaborative care pathway for patients undergoing retroperitoneal lymph node dissection. We examined its impact on perioperative care and outcome.
  
  
  METHODS
  We examined the records of all patients with germ cell carcinoma who underwent retroperitoneal lymph node dissection from July 1990 to July 2001. Variables examined included clinical/pathological stage, hospital stay, postoperative care and the complication rate.
  
  
  RESULTS
  A total of 118 patients underwent retroperitoneal lymph node dissection for germ cell carcinoma during this period, including 46 (39%) before pathway implementation in 1997 and 72 patients (61%) after pathway implementation. Of the 118 patients 40 (34%) underwent the procedure after chemotherapy. This rate remained fairly constant in the period before and after pathway initiation (31% and 36%, respectively). After pathway implementation fewer patients received a nasogastric tube (94% versus 5%, p <0.001) and had complications (26% versus 16%, p = 0.036). Mean hospital stay decreased after pathway implementation in all primary and post-chemotherapy retroperitoneal lymph node dissection cases (4.2 versus 6.4 days, p <0.005). Although patients who underwent the procedure after chemotherapy were more likely to have complications than those who underwent a primary procedure, the difference was not statistically significant (p = 0.09).
  
  
  CONCLUSIONS
  Our collaborative clinical care pathway safely and efficiently outlines routine postoperative care and significantly decreased hospital stay.
authors.affiliation: Department of Urologic Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Sam S
authors.initials: SS
authors.lastname: Chang
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Smith
authors.forename: Christopher
authors.initials: C
authors.lastname: Girasole
authors.forename: Roxelyn G
authors.initials: RG
authors.lastname: Baumgartner
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: Roth
authors.forename: Michael S
authors.initials: MS
authors.lastname: Cookson
mesh_terms: D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant; D019091:Critical Pathways; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology; D012187:Retroperitoneal Space; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*