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Vol.43 No.2 contents | Japanese/English |
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- Original Article -
A Clinical Pathway for Pulmonary Resections With Conventional Thoracotomies in Patients With Neoplastic Diseases
Kyota Iijima1,2, Ken Nakagawa1, Sakae Okumura1, Yukitoshi Sato1, Sigehiro Tsuchiya1,31Department of Chest Surgery, Cancer Institute Hospital, Japan, 2Dr Iijima is now with Alten Heim Rehabilitation Clinic, Japan, 3Dr Tsuchiya is now with Department of Surgery, Tsuchiya Hospital, Japan
Objective. There are no economical advantages to a clinical pathway system for either patients or hospitals in Japan because of the compulsory public medical case insurance piece rate system. The purpose of this study was to assess the effect of a clinical pathway on rationalization of postoperative management and outcome for pulmonary resections with conventional thoracotomies. Methods. All anatomic (segmentectomy, lobectomy, and pneumonectomy with or without tracheo/bronchoplasty) and partial pulmonary resections with conventional thoracotomies performed from January 1999 to December 2000 were retrospectively analyzed for postoperative pharmaceuticals, laboratory, radiologic, and physiologic tests, oxygen supply, and outcome. The clinical pathway for postoperative management was introduced in January 2000. Comparisons were made between the procedures performed before (control group) and after (path group) pathway implementation. Results. Intravenous drip (control vs. path: 5.2 days vs. 4.5), antibiotic use (5.6 times vs. 2.5), venous blood examination (5.1 times vs. 3.2), and arterial blood gas analysis (2.2 times vs. 0.1), chest X-ray (9.3 sheets vs. 6.5), electrocardiogram monitoring (139 hours vs. 101), and oxygen therapy (101 hours vs. 74), all were significantly greater in the control group than in the path group (all p<0.0002). There were no significant differences between two groups in postoperative complications, readmissions, or overall deaths for one year. Neither 30 day operative deaths nor hospital deaths occurred in either groups. Conclusions. Implementation of the clinical pathway system has resulted in a remarkable rationalization of postoperative management for conventional pulmonary resections with continued quality of outcome.
key words: Clinical pathway, Thoracotomy, Pulmonary resection, Postoperative management
Received: November 25, 2002
Accepted: February 7, 2003
JJLC 43 (2): 113-120, 2003
