Standardized measures speed postgastrectomy recovery

Last Updated: 2016-07-07

By David Douglas

NEW YORK (Reuters Health) - Standardization of medical care after total gastrectomy has led to a number of improvements, according to researchers at Memorial Sloan Kettering Cancer Center in New York.

As Dr. Vivian E. Strong told Reuters Health by email, "This study demonstrates the benefit of consensus care pathways for our patients and their experience and outcomes."

She and her colleagues found that standardization of postoperative care led to "earlier initiation of a clear liquid diet, sooner conversion to oral pain medications, decreased time receiving intravenous fluids, earlier removal of indwelling urinary catheters, and shortened length of stay."

In a June 14 online paper in Surgery, the researchers note that they came to these conclusions after studying outcomes between 2007 and 2011 in 51 patients who underwent the procedure before standardization and 48 who did so after its adoption.

The new standardized orders included initiation of a clear liquid diet (CLD) on postoperative day 1 -- given normal vital signs and abdominal examination. Ambulation also began on postoperative day 1, and fluids were discontinued when a postgastrectomy diet (PGD) was tolerated.

Patient-controlled analgesia or patient-controlled epidural anesthesia was instituted immediately following the operation, and analgesia was given once a PGD was tolerated. Enteral nutrition and naso-jejunal drainage were among procedures not routinely used.

Using the standardized approach, the time to postoperative initiation of a CLD fell from three to two days and a PGD began at four days rather than six. Epidural catheters were removed at five rather than six days and oral pain medication began at four instead of seven days.

The patients also spent less time receiving IV fluids (five versus seven days) and length of stay fell from nine to seven days.

Two surgeons accounted for most of the gastrectomies both before and after standardization and overall, when results were analyzed individually, both achieved similar improvements in most factors including length of stay.

Also when the periods were examined individually, say the investigators, "the data did not reveal a gradual improvement in clinical outcomes, only a decrease in the measured endpoints associated with the introduction of our standardized order set."

"Most importantly," Dr. Strong said, "there was no increase in complications, urgent care visits, or readmissions. We are hopeful that this will encourage other centers to standardize post-operative care."

The National Institutes of Health partially supported this research. The authors reported no disclosures.

SOURCE: http://bit.ly/29wbh6d

Surgery 2016.