|Impact of multidisciplinary standardised clinical pathway on perioperative outcomes in patients with oesophageal cancer|
|Monday, 04 March 2013|
SR Preston, SR Markar, CR Baker, et al. Br J Surg 2013; 100:105-12.
In a nutshell
The study highlights the involvement of all healthcare professionals in the clinical pathway. It included daily goals for early mobilisation, fluid balance/nutrition, analgesia, and removal of drains/tubes, towards a target discharge of day seven. Patients underwent oesophagectomy by a hybrid or open approach. The pathway group (12) was compared with non-pathway patients in the unit (12), patients prior to the pathway being introduced (12), and patients at VMMC (74).
Significant improvements were seen following introduction of the pathway in terms of early extubation, mobilisation, complications, length of critical care stay, and median length of hospital stay (from 17 to 7 days). There were no deaths in any group.
The study is limited by the small number of patients, and some differences between groups in terms of operating surgeon, and operative approach. Also, some aspects such as early extubation after surgery are already routine in many centres. Nevertheless, most surgeons would agree with the core points of the pathway and admire the attention to detail (such as new critical care beds and lighter drain bottles to aid mobilisation). Although discharge on day seven after oesophagectomy may not be adopted by all units there are certainly components of the pathway that should be.