Journal of Nippon Medical School
Online ISSN : 1347-3409
Print ISSN : 1345-4676
ISSN-L : 1345-4676
原著
胃切除患者におけるクリニカルパスの臨床的意義
木山 輝郎田尻 孝吉行 俊郎三橋 恭子伊勢 雄也水谷 崇奥田 武志藤田 逸郎増田 剛太郎加藤 俊二松倉 則夫徳永 昭長谷川 幸子
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ジャーナル フリー

2003 年 70 巻 3 号 p. 263-269

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In traditional practice patterns, physicians take care of all clinical decisions, such as diagnosis, treatment, and recovery. In the Nippon Medical School Hospital a clinical pathway for distal gastrectomy patients, recorded as a post-operative care map, was introduced in August 2000. In January 2001 the post-operative management was analyzed and standardization of practice was carried out with printed order sets, such as drugs and infusion solutions. The aim of this study was to evaluate the clinical significance of the clinical pathway for gastrectomy patients by employing standardized postoperative management and printed order sets.
Patients and methods: From January 2001 to December 2001, 87 patients underwent distal (43), total (28), proximal (7) and partial gastrectomy (9) for gastric cancer (stage IA: 47, IB: 9, II: 7, IIIA: 8, IIIB 2, IV: 10) and gastrointestinal stromal tumor (4). These patients were randomly assigned to either the main building or the east building of our hospital. In the main building 38 patients were looked after using traditional practice (control group). In the east building 47 patients were looked after according to the clinical pathway (path group) and 2 patients were excluded from the path group because of neo-adjuvant chemotherapy and severe heart failure. Aspects of the patients' outcomes, including length of stay, the first day of the diet, morbidity, and medical costs, were compared between the path group and the control group. All data were expressed as means±standard deviation. Statistical analyses were made using Student t-test, Mann-Whitney U-test, and χ2 test, and the 5%level was chosen for statistical significance.
Results: The length of the hospital stay was 27.1±10.0 and 40.8±26.1 days (p<0.005) and the length of post-operative stay was 18.1±9.5 and 28.2±22.3 days (p<0.01) in the path group and the control group, respectively. The post-operative day when the diet was started for the path and control groups was 6.8±8.9 and 8.2±7.2, respectively; however, the length of the intravenous infusion for the two groups was 11.8±1.1 and 16.5±1.2 days (p<0.01), respectively. There was no statistically significant difference in the morbidity rate between the path group (3/47) and the control group (5/38). The total cost was \1,502,587±41,650 in the path group and \1,932,197±131,030 in the control (p<0.001).
Conclusion: A clinical pathway for gastrectomy patients proved useful to optimize their postoperative care, including medication management and diet education. It is suggested that the implementation of a standardized clinical pathway for gastrectomy patients reduced the length of the hospital stay and the medical costs.

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© 2003 日本医科大学医学会
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