title: Clinical pathway to discharge 3 days after colorectal endoscopic submucosal dissection.
abstract: OBJECTIVE
  Colorectal endoscopic submucosal dissection (ESD) is a useful treatment method; however, no index has been established for time for patient to start food ingestion or be discharged after ESD. We investigated the potential of a clinical pathway in which patients started food ingestion on day 2 after ESD and were discharged on day 3.
  
  
  METHODS
  A total of 382 patients underwent colorectal ESD between 2006 and 2012. A flow chart of a clinical pathway was prepared based on the data obtained, with the aim of shortening hospital stay after ESD.
  
  
  RESULTS
  Mean duration of postoperative hospital stay in the 382 patients was 5.3 ± 1.8 days. The most common cause of extended hospital stay was abnormal blood test finding, as detected in 50 patients in group C (n = 131; 38.2%), followed by careful course observations, as noted in 48 patients in group C (n = 131; 36.6%). Regarding procedural accidents as a result of ESD, intraoperative perforation occurred in 15 patients (3.9%) and post-ESD bleeding in seven patients (1.8%), which extended the hospital stay. Food ingestion was started on day 2 when no abnormality was noted during ESD or in physical and imaging findings or blood tests on day 1. In the 86 patients who underwent the prepared clinical pathway as a validation study, 68 (79.0%) were discharged on day 3. Duration of postoperative hospital stay was 3.4 ± 1.2 days.
  
  
  CONCLUSIONS
  Discharge may be possible 3 days after ESD when no abnormalities are noted during ESD or on post-ESD day 1.
authors.affiliation: Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Tomiki
authors.affiliation: Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan.
authors.forename: Masaya
authors.initials: M
authors.lastname: Kawai
authors.affiliation: Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Takehara
authors.affiliation: Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Tashiro
authors.affiliation: Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Munakata
authors.affiliation: Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan.
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Kure
authors.affiliation: Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan.
authors.forename: Shun
authors.initials: S
authors.lastname: Ishiyama
authors.affiliation: Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan.
authors.forename: Kiichi
authors.initials: K
authors.lastname: Sugimoto
authors.affiliation: Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan.
authors.forename: Hirohiko
authors.initials: H
authors.lastname: Kamiyama
authors.affiliation: Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Takahashi
authors.affiliation: Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Sakamoto
mesh_terms: D000368:Aged; D019540:Area Under Curve; D015331:Cohort Studies; D003113:Colonoscopy / Q000009:adverse effects / Q000379:methods*; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016001:Confidence Intervals; D019091:Critical Pathways; D004210:Dissection / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000401:mortality; D016017:Odds Ratio; D010351:Patient Discharge / Q000592:standards* / Q000639:trends; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
keywords: clinical pathway; colorectal endoscopic submucosal dissection (ESD); hospital stay; incident; medical fee point