Clinical Pathway Established for Colorectal Surgical Procedures

08/10/17

A new clinical pathway has been designed and implemented to improve colon and rectal surgical procedures and enhance successful patient recovery, published in the Journal of the American College of Surgeons (online August 7, 2017; doi: 10.1016/j.jamcollsurg.2017.06.017).

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The standardized care plan will be included in a nationwide program for hospitals to improve the recovery of surgical patients. It provides a comprehensive collaboration of crucial elements of enhanced recovery, in conjunction with the current United States guidelines for prevention of common postoperative complications, including surgical site infection, venous thromboembolus, and catheter-associated urinary tract infection.

"Our work is unique because it's not just a guideline. It is an evidence-based review as part of a larger implementation program that will support and help hundreds of hospitals translate best evidence for perioperative care into clinical practice," said Elizabeth Wick, MD, FACS, associate professor of surgery, University of California San Francisco, in an interview (August 8, 2017).

The implementation program Dr Wick refers to (Safety Program for Improving Surgical Care and Recovery) is funded by the Agency for Healthcare Research and Quality and administered by the American College of Surgeons. Goals of the program are to improve clinical outcomes and the patient experience, reduce complications and hospital length-of-stay, and increase efficiency. Hospitals that choose to participate in the program will receive education, tools, and coaching support as they begin implementing the pathway.

The colorectal clinical pathway is a 12-component plan derived from a systematic review of original studies, articles, organizational guidelines, and expert opinions published before December 2016. The components range from preoperative measures—such as patient education about the operation—to postoperative procedures – including early removal of the urinary bladder catheter to prevent tract infections.

Another pathway component is mechanical bowel preparation (bowel emptying) plus oral antibiotic therapy before a non-emergency colorectal operation. The Enhanced Recovery After Surgery Society recommends against bowel preparation due to risk of dehydration, but this risk is outweighed by a reduced chance of surgical site infections, according to Dr Wick.

Hospitals that choose to participate in the program will also have access to a registry that tracks pathway compliance. Participants will be able to input their length-of-stay and readmission rates into this database to receive benchmark comparisons with other participants’ performances.—Zachary Bessette