The American Journal of Surgery
Volume 199, Issue 3 , Pages 299-304, March 2010

Association of surgical care practices with length of stay and use of clinical protocols after elective bowel resection: results of a national survey

  • Conor P. Delaney, M.D., M.Ch., Ph.D.

      Affiliations

    • Division of Colorectal Surgery, University Hospitals Case Medical Center, 11100 Euclid Ave., Cleveland, OH 44106-5047
    • Corresponding Author InformationCorresponding author: Tel.: +1-216-844-8087; fax: +1-216-844-5957
    • ,
  • Anthony J. Senagore, M.D., M.B.A., M.S.

      Affiliations

    • Spectrum Health System, Grand Rapids, MI
    • ,
  • Todd M. Gerkin, M.D.

      Affiliations

    • Central Carolina Surgery, Greensboro, NC
    • ,
  • Timothy L. Beard, M.D.

      Affiliations

    • Bend Memorial Clinic, Bend, OR
    • ,
  • Wendy M. Zingaro, M.P.A.

      Affiliations

    • KJT Group, Honeoye Falls, NY
    • ,
  • Kenneth J. Tomaszewski, Ph.D., M.S.

      Affiliations

    • KJT Group, Honeoye Falls, NY
    • ,
  • Laura K. Walton

      Affiliations

    • Adolor Corporation, Exton, PA
    • ,
  • Sara A. Poston, Pharm.D.

      Affiliations

    • GlaxoSmithKline, Research Triangle Park, NC, USA

Received 22 July 2009; received in revised form 25 August 2009

Abstract 

Background

Although management techniques have been proposed to accelerate gastrointestinal recovery after elective bowel resection (BR), most data are derived from single-institution experience. This study assessed the current state of perioperative care for elective BRs and the effect of pathway components on length of stay.

Methods

A web-based survey was conducted among surgeons regarding their last elective BR.

Results

Among 207 general and 200 colorectal surgeons, 30% practice in hospitals with a perioperative surgical care pathway intended to accelerate gastrointestinal recovery. Pathway components included early ambulation, early diet progression, early nasogastric tube removal/avoidance, and opioid-sparing pain control. Care practices associated with decreased length of stay included laparoscopic technique, early mobilization, early liquids, and antiemetic use to prevent symptoms associated with prolonged postoperative ileus.

Conclusions

Few hospitals have pathways but most surgeons likely would implement nationally endorsed guidelines. These data, along with other studies, may lead to well-accepted BR care pathways.

Keywords: Postoperative ileus, Clinical pathway, Enhanced recovery pathway, Bowel resection, Perioperative care

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 Funding for design and for medical editorial assistance for the manuscript was provided by GlaxoSmithKline and Adolor Corporation. Drs Delaney, Senagore, Gerkin, and Beard received funding to assist with the survey design (funding was not provided for analysis or for participating as an author); Dr Tomaszewski and Ms Zingaro received support for design, fielding, and analysis; Dr Poston is an employee of GlaxoSmithKline; and Ms Walton is an employee of Adolor Corporation.

 This manuscript has been reviewed and approved for submission by all authors and has not been published elsewhere.

PII: S0002-9610(09)00686-2

doi:10.1016/j.amjsurg.2009.08.027

The American Journal of Surgery
Volume 199, Issue 3 , Pages 299-304, March 2010

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