title: A clinical pathway for patients undergoing primary cytoreductive surgery with rectosigmoid colectomy for advanced ovarian and primary peritoneal cancers.
abstract: OBJECTIVE
  To evaluate the safety, feasibility, and economic impact of a clinical pathway, including rapid diet advancement, for patients undergoing rectosigmoid colectomy as part of cytoreductive surgery for advanced ovarian and primary peritoneal cancers.
  
  
  METHODS
  Between 8/1/98 and 6/30/06, 64 consecutive patients met study inclusion criteria. Using case-control methodology, post-operative management was dictated by a prescribed clinical pathway in 19 patients (Group A) and directed by individual surgeon preference in 45 patients (Group B). Critical elements of the clinical pathway included: rapid diet advancement, early discontinuance of nasogastric suction, criteria-based utilization of parenteral nutrition, selective laboratory testing, and deferring initiation of chemotherapy until after discharge.
  
  
  RESULTS
  Stage IIIC/IV disease was present in 94% of all patients. The median time to flatus was 6 days for both groups (p=0.95); however, the median time to tolerance of diet was 3 days for Group A and 6 days for Group B (p=0.013). Compared to Group B, patients in Group A had a significantly shorter median length of hospital stay (7 days vs 10 days, p=0.014) and lower median 30-day post-operative hospital cost ($19,700 vs $25,110, p=0.028), with no significant difference in 30-day readmission rate (21% vs 33%, p=0.379). Clinical pathway-directed management was associated with a median reduction in hospital cost of $5410 per patient.
  
  
  CONCLUSIONS
  A critical pathway incorporating rapid diet advancement for patients undergoing primary cytoreductive surgery with rectosigmoid colectomy for ovarian and primary peritoneal cancers is feasible, safe, and associated with a significant reduction in length of hospital stay and hospital-related costs.
authors.affiliation: The Kelly Gynecologic Oncology Service, Department of Obstetrics and Gynecology, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Gerardi
authors.forename: Antonio
authors.initials: A
authors.lastname: Santillan
authors.forename: Benjamin
authors.initials: B
authors.lastname: Meisner
authors.forename: Marianna L
authors.initials: ML
authors.lastname: Zahurak
authors.forename: Teresa P
authors.initials: TP
authors.lastname: Diaz Montes
authors.forename: Robert L
authors.initials: RL
authors.lastname: Giuntoli
authors.forename: Robert E
authors.initials: RE
authors.lastname: Bristow
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003082:Colectomy / Q000191:economics / Q000379:methods*; D004032:Diet; D005260:Female; D006801:Humans; D007441:Intubation, Gastrointestinal; D008875:Middle Aged; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000191:economics / Q000473:pathology / Q000601:surgery*; D010534:Peritoneal Neoplasms / Q000191:economics / Q000473:pathology / Q000601:surgery*; D011182:Postoperative Care / Q000379:methods