title: Perioperative quality of care is modulated by process management with clinical pathways for fast-track surgery of the colon.
abstract: OBJECTIVE
  Clinical pathways (CPs) are increasingly used to improve quality of care. However, evidence if such improvements are also feasible in fast-track colorectal surgery is lacking. This study evaluates effects of a CP for fast-track colonic resections with respect to process and outcome quality.
  
  
  METHODS
  We compared 78 consecutive patients undergoing colonic resections in 2008 and being treated with a CP (CP group) with 133 consecutive patients treated without CP between 2006 and 2007 (pre-CP group). Indicators for process quality were epidural catheter placement, postoperative mobilisation, resumption of solid diet, Foley catheter removal and length of stay. Outcome quality was measured through morbidity, mortality, re-operations and readmissions.
  
  
  RESULTS
  In the CP group, patients received epidural analgesia significantly more often (87.2% vs. 75.2%; p =0.04), were mobilized (38.9% vs. 20.6% on the day of surgery; p = 0.03) and resumed a solid diet earlier (60.5% vs. 49.6% on day 1; p = 0.002). Foley catheter removal and length of stay did not differ between the groups. There were no significant differences regarding morbidity (28.2% vs. 32.3%), mortality (1.2% vs. 2.3%), re-operations (6.4% vs. 9.0%) and readmissions (2.6% vs. 3.8%).
  
  
  CONCLUSIONS
  After CP implementation for fast-track surgery of the colon, several indicators of process quality improved while others such as length of stay remained unaltered. There were no significant changes in outcome parameters. CPs are a viable instrument to improve specific aspects of perioperative process management, but their selective benefits have to be critically weighed against the infrastructural and personal efforts required for design and implementation.
authors.affiliation: Department of General, Visceral, Vascular, and Thoracic Surgery, Klinikum Frankfurt Höchst, Gotenstrasse 6-8, 68150, Frankfurt a. M., Germany. matthias.schwarzbach@klinikumfrankfurt.de
authors.forename: Matthias
authors.initials: M
authors.lastname: Schwarzbach
authors.forename: Till
authors.initials: T
authors.lastname: Hasenberg
authors.forename: Miriam
authors.initials: M
authors.lastname: Linke
authors.forename: Peter
authors.initials: P
authors.lastname: Kienle
authors.forename: Stefan
authors.initials: S
authors.lastname: Post
authors.forename: Ulrich
authors.initials: U
authors.lastname: Ronellenfitsch
mesh_terms: D000368:Aged; D003106:Colon / Q000601:surgery*; D019091:Critical Pathways / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D019990:Perioperative Care / Q000379:methods* / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards*; D012015:Reference Standards; D016896:Treatment Outcome