| Abstract | OBJECTIVES: 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 | Melissa A Gerardi, Antonio Santillan, Benjamin Meisner, Marianna L Zahurak, Teresa P Diaz Montes, Robert L Giuntoli 2nd, Robert E Bristow
(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.)
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| Journal | Gynecologic oncology
(Gynecol Oncol)
Vol. 108
Issue 2
Pg. 282-6
(Feb 2008)
ISSN: 1095-6859 United States |
| PMID | 18023851
(Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)
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| Topics |
- Adult
- Aged
- Aged, 80 and over
- Case-Control Studies
- Colectomy
(economics, methods)
- Diet
- Female
- Humans
- Intubation, Gastrointestinal
- Middle Aged
- Neoplasm Staging
- Ovarian Neoplasms
(economics, pathology, surgery)
- Peritoneal Neoplasms
(economics, pathology, surgery)
- Postoperative Care
(methods)
|
