Impact of a fast-track clinical pathway on perioperative outcomes in patients undergoing ileal/ileocecal resection for chronic radiation enteritis with intestinal obstruction        ZHANG Liang, GONG Jian-feng, NI Ling , et al.Research Institute of General Surgery, Nanjing General Hospital of Nanjing Military Command, PLA, Clinical School of Medical College, Nanjing University, Nanjing 210002, China
Abstract    Objective    To evaluate the effect of a fast-track-based clinical pathway on postoperative outcome in patients undergoing ileal/ileocecal resection for chronic radiation enteritis (CRE) with intestinal obstruction.Methods   Between2011.01 and 2013.03, a total of 85 CRE patients with intestinal obstruction admitted to our department for ileal/ileocecal resection were categorized into a prepathway group and a pathway group.This corresponded to the implementation of the clinical pathway in January 2012. The 37 patients in the pathway group were managed according to a multidisciplinary program, while the 48 patients in the prepathway  group were managed conventionally.The clinical outcomes and hospital costs were then assessed and compared. Results    The two groups were similar in terms of demographics, comorbidities, radiation dose and ASA score. The postoperative length of hospital stay(LOS) was 8.52 days for the pathway group and 11.32 days for the prepathway group (P = 0.02), and the total LOS in the two groups were 21.63 and 20.82 days, respectively (P=0.589). The cost of hospitalization for the pathway patients was 66610 RMB, which was lower compared to the 76546 RMB cost for the pre-pathway patients (P=0.136). The pathway group had a lower stoma rate(21.6% vs 56% , P=0.033)and less postoperative moderate to severe(Clavien Ⅲ-Ⅴ) complication(8.1%vs 25%, P=0.043) as compared to prepathway group. Conclusion    A fast-track based clinical pathways may reduce stoma rate, postoperative moderate to severe(Clavien Ⅲ-Ⅴ) complication, postoperative length of hospital stay and costs for patients undergoing ileal/ileocecal resection for the treatment of chronic radiation enteritis (CRE) with intestinal obstruction.