Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection.
BACKGROUND
In an era of dwindling hospital resources and increasing medical costs, safe reduction in postoperative stay has become a major focus to optimize utilization of healthcare resources. Although several protocols have been reported to reduce postoperative stay, no Level I evidence exists for their use in routine clinical practice.


METHODS
Sixty-four patients undergoing laparotomy and intestinal or rectal resection were randomly assigned to a pathway of controlled rehabilitation with early ambulation and diet or to traditional postoperative care. Time to discharge from hospital, complication and readmission rates, pain level, quality of life, and patient satisfaction scores were determined at the time of discharge and at 10 and 30 days after surgery. Subgroups were defined to evaluate those who derived the optimal benefit from the protocol.


RESULTS
Pathway patients spent less total time in the hospital after surgery (5.4 vs. 7.1 days; P = 0.02) and less time in the hospital during the primary admission than traditional patients. Patients younger than 70 years old had greater benefits than the overall study group (5 vs. 7.1 days; P = 0.01). Patients treated by surgeons with the most experience with the pathway spent significantly less time in the hospital than did those whose surgeons were less experienced with the pathway (P = 0.01). There was no difference between pathway and traditional patients for readmission or complication rates, pain score, quality of life after surgery, or overall satisfaction with the hospital stay.


CONCLUSIONS
Patients scheduled for a laparotomy and major intestinal or rectal resection are suitable for management by a pathway of controlled rehabilitation with early ambulation and diet. Pathway patients have a shorter hospital stay, with no adverse effect on patient satisfaction, pain scores, or complication rates. Patients younger than 70 years of age derive the optimal benefit, and increased surgeon experience improves outcome.
Delaney
Conor P
CP
Department of Colorectal Surgery, Cleveland Clinic Foundation, Ohio 44195, USA.
Zutshi
Massarat
M
Senagore
Anthony J
AJ
Remzi
Feza H
FH
Hammel
Jeffrey
J
Fazio
Victor W
VW
D000328:Adult; D000368:Aged; D003082:Colectomy / Q000534:rehabilitation*; D019091:Critical Pathways; D004434:Early Ambulation; D005248:Feeding Methods; D005260:Female; D006801:Humans; D007081:Ileostomy; D007813:Laparotomy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D017060:Patient Satisfaction; D011182:Postoperative Care / Q000379:methods*; D011446:Prospective Studies; D011788:Quality of Life