[Self-evaluation of a clinical pathway to improve the results of rectal cancer]. / Autoevaluación de una vía clínica para mejora del proceso quirúrgico carcinoma de recto.
Cir Esp
; 87(4): 231-8, 2010 Apr.
Article
em Es
| MEDLINE
| ID: mdl-20206342
ABSTRACT
OBJECTIVES:
To analyse whether the self-evaluation of a clinical pathway improves the results of rectal cancer (RC) treatment. PATIENTS ANDMETHOD:
Patients operated on for RC were divided into 3 groups according to biannual modifications of a clinical pathway analysing several indicators.RESULTS:
166 patients Group A 2002-3 n=50, B 2004-5 n=53 and C 2006-7 n=63, without any differences in age, gender or comorbidity. Preoperative study improved with the introduction of CT scan 76% in Group C vs. 6% in Group A (P<0.001). All Group C tumours were staged using MR, rectal ultrasound or both, compared to 84% in Group A (P<0.001). The rate of abdominal-perineal resections was reduced from 42% (Group A) to 17% (Group C); (P=0.007) and about 48% of surgeons in Group A vs. 94% in the C had a specific activity in coloproctology (P<0.001). The average lymph node count was Group A=6.2+/-4.5 vs. 13+/-6.5 in the C and circumferential margin analysis was reported in 24% of Group A vs. 76% in Group C (P<0.001). Parameters such as perioperative blood transfusion, ICU admission, use of nasogastric tube, early feeding or epidural analgesia also improved progressively. Operative mortality decreased non-significantly to 4.7% and anastomotic leaks from 24% to 9.5% with a reduction in postoperative stay from 15 to 11 days during the period analysed (P=0.029).CONCLUSIONS:
Several indicators have significantly improved in a relatively short period of time due to self-evaluations of the process.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Neoplasias Retais
/
Autoimagem
/
Atitude Frente a Saúde
Tipo de estudo:
Guideline
Limite:
Aged
/
Female
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Humans
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Male
Idioma:
Es
Ano de publicação:
2010
Tipo de documento:
Article