Clinical and organizational content of clinical pathways for digestive surgery: a systematic review.
OBJECTIVE
Oncology surgery of the gastrointestinal tract is complex and infamous for its high complication rates. One of the methods for implementing interventions to optimize the patients' condition and to enhance postoperative outcome is the development and implementation of a clinical pathway. The aim of this study was to analyze the content, i.e. the interventions of clinical pathways for digestive surgery and their effects on postoperative outcome measures.


METHODS
We performed a systematic review to study clinical pathways in hospital care for adult patients undergoing elective surgery of the stomach, esophagus, pancreas, liver, colon or rectum. The MEDLINE, EMBASE and CINAHL literature databases were searched.


RESULTS
The most common interventions in the clinical pathways in this review were defined in the pre- and postoperative phase and included: nutritional management, pain management, mobilization, education and discharge planning. The primary aim of these interventions was to enhance postoperative recovery.


CONCLUSIONS
Clinical pathways for digestive surgery contain specific interventions to improve postoperative outcome. Most of these interventions are in accordance with the Enhanced Recovery After Surgery (ERAS) protocol, which is an evidence-based protocol for care after colon resections. They result in reduced length of stay without compromising other postoperative outcome measures.
Lemmens
L
L
Department of Perioperative and Emergency Care, University Medical Center Utrecht, Utrecht, The Netherlands. lidwien.lemmens@rivm.nl
van Zelm
R
R
Borel Rinkes
I
I
van Hillegersberg
R
R
Kerkkamp
H
H
D000328:Adult; D000368:Aged; D019091:Critical Pathways; D013505:Digestive System Surgical Procedures / Q000592:standards*; D006801:Humans; D008875:Middle Aged; D016896:Treatment Outcome