Impact of Implementation of a Clinical Pathway for Adhesive Small Bowel Obstruction

Takamasa Takahashi, Kanji Miyata, Masaya Watanabe, Norihiro Yuasa, Eiji Takeuchi, Yasutomo Goto, Hideo Miyake, Keiichi Nagasawa, Kenji Omori and Yoichiro Kobayashi

Department of Surgery, Japanese Red Cross Nagoya Daiichi Hospital

Background and aim: Clinical pathway (CP) benefits have been reported in gastrointestinal surgery, but few studies have focused on CP for adhesive small bowel obstruction (ASBO). We developed an ASBO CP using a nasogastric (NG) tube in the early phase and studied its clinical usefulness. Patients and Methods: We reviewed the clinical courses of 116 patients with ASBO 68 treated with CP and 48 not treated. We compared hospital stay and charges and analyzed causes of off-CP cases. Results: (1) Of the 68 patients for which the CP was used, 54 (79%) completed the CP with a mean hospital stay of 8.8 days. (2) The mean hospital stay of all patients decreased from 16.5 days to 14.4. The mean hospital stay for patients with successful conservative therapy was significantly reduced from 12.6 days to 9.2 (p=0.045). The mean hospital charge for all patients decreased from 458,950 yen to 436,310 yen, while the mean hospital charge per day of all patients significantly increased from 28,310 yen to 30,370 yen (p=0.018). (3) Total discharge from the NG tube for 24 hours between the first and second hospital day differed significantly between on-CP and off-CP cases. When a total-volume cutoff is set at 270 ml, this significantly differentiates on-CP cases from off-CP (p<0.0001). Conclusion: The ASBO CP decreased hospital stay and charges, but hospital charge per day increased. It is thus possible to estimate the CP deviation by measuring total NG tube discharge for 24 hrs between the first and second hospital day.

Key words
adhesive small bowel obstruction, ileus, clinical pathway

Reprint requests
Takamasa Takahashi National Cancer Center Hospital
5-1-1 Tsukiji, Chuo-ku, 104-0045 JAPAN

Accepted
May 27, 2009

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