Clinical pathway to discharge 3 days after colorectal endoscopic submucosal dissection
Background and Aim Colorectal endoscopic submucosal dissection (ESD) is a useful treatment method; however, no index has been established for time for patient to start food ingestion or be discharged after ESD. We investigated the potential of a clinical pathway in which patients started food ingest...
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| Veröffentlicht in: | Digestive endoscopy 2015-09, Vol.27 (6), p.679-686 |
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| creator | Tomiki, Yuichi Kawai, Masaya Takehara, Kazuhiro Tashiro, Yoshihiko Munakata, Shinya Kure, Kazumasa Ishiyama, Shun Sugimoto, Kiichi Kamiyama, Hirohiko Takahashi, Makoto Sakamoto, Kazuhiro |
| description | Background and Aim
Colorectal endoscopic submucosal dissection (ESD) is a useful treatment method; however, no index has been established for time for patient to start food ingestion or be discharged after ESD. We investigated the potential of a clinical pathway in which patients started food ingestion on day 2 after ESD and were discharged on day 3.
Methods
A total of 382 patients underwent colorectal ESD between 2006 and 2012. A flow chart of a clinical pathway was prepared based on the data obtained, with the aim of shortening hospital stay after ESD.
Results
Mean duration of postoperative hospital stay in the 382 patients was 5.3 ± 1.8 days. The most common cause of extended hospital stay was abnormal blood test finding, as detected in 50 patients in group C (n = 131; 38.2%), followed by careful course observations, as noted in 48 patients in group C (n = 131; 36.6%). Regarding procedural accidents as a result of ESD, intraoperative perforation occurred in 15 patients (3.9%) and post‐ESD bleeding in seven patients (1.8%), which extended the hospital stay. Food ingestion was started on day 2 when no abnormality was noted during ESD or in physical and imaging findings or blood tests on day 1. In the 86 patients who underwent the prepared clinical pathway as a validation study, 68 (79.0%) were discharged on day 3. Duration of postoperative hospital stay was 3.4 ± 1.2 days.
Conclusion
Discharge may be possible 3 days after ESD when no abnormalities are noted during ESD or on post‐ESD day 1. |
| doi_str_mv | 10.1111/den.12468 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1711546301</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1711546301</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5238-e38a8842f248fc4e5d45d2c4d7decc0b0ea734153277f7c6dcaff4c20cff3f473</originalsourceid><addsrcrecordid>eNp1kE9PGzEQxS1UBCntgS-A9tgeFvzfmyNKSYpAoYcCvVlmPIaFzTrYG9F8-7oEcmMuI8383tPMI-SQ0WNW6sRjf8y41M0OGTEpRc20Zp_IiI6ZqpUWap98zvmRUsbHUu6Rfa6M0prqEbmZdG3fguuqpRseXty6GmLl2wwPLt1jJSrv1rlyYcBUQexiQhgKjL2PGeKyhSqv7hYriLlMiy6XfRv7L2Q3uC7j17d-QK6nZ78nP-vLq9n55PSyBsVFU6NoXNNIHrhsAkhUXirPQXrjEYDeUXRGSKYENyYY0B5cCBI4hRBEkEYckG8b32WKzyvMg12U27HrXI9xlS0zjCmpBWUF_b5BIcWcEwa7TO3CpbVl1P6P0ZYY7WuMhT16sy3Pod-S77kV4GQDvLQdrj92sj_O5u-W9UbR5gH_bhUuPVlthFH2dj6zSt5Of138Gdux-Afa3Ixx</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1711546301</pqid></control><display><type>article</type><title>Clinical pathway to discharge 3 days after colorectal endoscopic submucosal dissection</title><source>MEDLINE</source><source>Wiley Journals</source><creator>Tomiki, Yuichi ; Kawai, Masaya ; Takehara, Kazuhiro ; Tashiro, Yoshihiko ; Munakata, Shinya ; Kure, Kazumasa ; Ishiyama, Shun ; Sugimoto, Kiichi ; Kamiyama, Hirohiko ; Takahashi, Makoto ; Sakamoto, Kazuhiro</creator><creatorcontrib>Tomiki, Yuichi ; Kawai, Masaya ; Takehara, Kazuhiro ; Tashiro, Yoshihiko ; Munakata, Shinya ; Kure, Kazumasa ; Ishiyama, Shun ; Sugimoto, Kiichi ; Kamiyama, Hirohiko ; Takahashi, Makoto ; Sakamoto, Kazuhiro</creatorcontrib><description>Background and Aim
Colorectal endoscopic submucosal dissection (ESD) is a useful treatment method; however, no index has been established for time for patient to start food ingestion or be discharged after ESD. We investigated the potential of a clinical pathway in which patients started food ingestion on day 2 after ESD and were discharged on day 3.
Methods
A total of 382 patients underwent colorectal ESD between 2006 and 2012. A flow chart of a clinical pathway was prepared based on the data obtained, with the aim of shortening hospital stay after ESD.
Results
Mean duration of postoperative hospital stay in the 382 patients was 5.3 ± 1.8 days. The most common cause of extended hospital stay was abnormal blood test finding, as detected in 50 patients in group C (n = 131; 38.2%), followed by careful course observations, as noted in 48 patients in group C (n = 131; 36.6%). Regarding procedural accidents as a result of ESD, intraoperative perforation occurred in 15 patients (3.9%) and post‐ESD bleeding in seven patients (1.8%), which extended the hospital stay. Food ingestion was started on day 2 when no abnormality was noted during ESD or in physical and imaging findings or blood tests on day 1. In the 86 patients who underwent the prepared clinical pathway as a validation study, 68 (79.0%) were discharged on day 3. Duration of postoperative hospital stay was 3.4 ± 1.2 days.
Conclusion
Discharge may be possible 3 days after ESD when no abnormalities are noted during ESD or on post‐ESD day 1.</description><identifier>ISSN: 0915-5635</identifier><identifier>EISSN: 1443-1661</identifier><identifier>DOI: 10.1111/den.12468</identifier><identifier>PMID: 25756606</identifier><language>eng</language><publisher>Australia: Blackwell Publishing Ltd</publisher><subject>Aged ; Area Under Curve ; clinical pathway ; Cohort Studies ; Colonoscopy - adverse effects ; Colonoscopy - methods ; colorectal endoscopic submucosal dissection (ESD) ; Colorectal Neoplasms - mortality ; Colorectal Neoplasms - pathology ; Colorectal Neoplasms - surgery ; Confidence Intervals ; Critical Pathways ; Dissection - adverse effects ; Dissection - methods ; Female ; hospital stay ; Humans ; incident ; Intestinal Mucosa - pathology ; Intestinal Mucosa - surgery ; Length of Stay ; Male ; medical fee point ; Middle Aged ; Minimally Invasive Surgical Procedures - methods ; Minimally Invasive Surgical Procedures - mortality ; Odds Ratio ; Patient Discharge - standards ; Patient Discharge - trends ; Prognosis ; Retrospective Studies ; Risk Assessment ; ROC Curve ; Survival Rate ; Time Factors ; Treatment Outcome</subject><ispartof>Digestive endoscopy, 2015-09, Vol.27 (6), p.679-686</ispartof><rights>2015 The Authors. Digestive Endoscopy © 2015 Japan Gastroenterological Endoscopy Society</rights><rights>2015 The Authors. Digestive Endoscopy © 2015 Japan Gastroenterological Endoscopy Society.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5238-e38a8842f248fc4e5d45d2c4d7decc0b0ea734153277f7c6dcaff4c20cff3f473</citedby><cites>FETCH-LOGICAL-c5238-e38a8842f248fc4e5d45d2c4d7decc0b0ea734153277f7c6dcaff4c20cff3f473</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fden.12468$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fden.12468$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25756606$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tomiki, Yuichi</creatorcontrib><creatorcontrib>Kawai, Masaya</creatorcontrib><creatorcontrib>Takehara, Kazuhiro</creatorcontrib><creatorcontrib>Tashiro, Yoshihiko</creatorcontrib><creatorcontrib>Munakata, Shinya</creatorcontrib><creatorcontrib>Kure, Kazumasa</creatorcontrib><creatorcontrib>Ishiyama, Shun</creatorcontrib><creatorcontrib>Sugimoto, Kiichi</creatorcontrib><creatorcontrib>Kamiyama, Hirohiko</creatorcontrib><creatorcontrib>Takahashi, Makoto</creatorcontrib><creatorcontrib>Sakamoto, Kazuhiro</creatorcontrib><title>Clinical pathway to discharge 3 days after colorectal endoscopic submucosal dissection</title><title>Digestive endoscopy</title><addtitle>Digestive Endoscopy</addtitle><description>Background and Aim
Colorectal endoscopic submucosal dissection (ESD) is a useful treatment method; however, no index has been established for time for patient to start food ingestion or be discharged after ESD. We investigated the potential of a clinical pathway in which patients started food ingestion on day 2 after ESD and were discharged on day 3.
Methods
A total of 382 patients underwent colorectal ESD between 2006 and 2012. A flow chart of a clinical pathway was prepared based on the data obtained, with the aim of shortening hospital stay after ESD.
Results
Mean duration of postoperative hospital stay in the 382 patients was 5.3 ± 1.8 days. The most common cause of extended hospital stay was abnormal blood test finding, as detected in 50 patients in group C (n = 131; 38.2%), followed by careful course observations, as noted in 48 patients in group C (n = 131; 36.6%). Regarding procedural accidents as a result of ESD, intraoperative perforation occurred in 15 patients (3.9%) and post‐ESD bleeding in seven patients (1.8%), which extended the hospital stay. Food ingestion was started on day 2 when no abnormality was noted during ESD or in physical and imaging findings or blood tests on day 1. In the 86 patients who underwent the prepared clinical pathway as a validation study, 68 (79.0%) were discharged on day 3. Duration of postoperative hospital stay was 3.4 ± 1.2 days.
Conclusion
Discharge may be possible 3 days after ESD when no abnormalities are noted during ESD or on post‐ESD day 1.</description><subject>Aged</subject><subject>Area Under Curve</subject><subject>clinical pathway</subject><subject>Cohort Studies</subject><subject>Colonoscopy - adverse effects</subject><subject>Colonoscopy - methods</subject><subject>colorectal endoscopic submucosal dissection (ESD)</subject><subject>Colorectal Neoplasms - mortality</subject><subject>Colorectal Neoplasms - pathology</subject><subject>Colorectal Neoplasms - surgery</subject><subject>Confidence Intervals</subject><subject>Critical Pathways</subject><subject>Dissection - adverse effects</subject><subject>Dissection - methods</subject><subject>Female</subject><subject>hospital stay</subject><subject>Humans</subject><subject>incident</subject><subject>Intestinal Mucosa - pathology</subject><subject>Intestinal Mucosa - surgery</subject><subject>Length of Stay</subject><subject>Male</subject><subject>medical fee point</subject><subject>Middle Aged</subject><subject>Minimally Invasive Surgical Procedures - methods</subject><subject>Minimally Invasive Surgical Procedures - mortality</subject><subject>Odds Ratio</subject><subject>Patient Discharge - standards</subject><subject>Patient Discharge - trends</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>ROC Curve</subject><subject>Survival Rate</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0915-5635</issn><issn>1443-1661</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kE9PGzEQxS1UBCntgS-A9tgeFvzfmyNKSYpAoYcCvVlmPIaFzTrYG9F8-7oEcmMuI8383tPMI-SQ0WNW6sRjf8y41M0OGTEpRc20Zp_IiI6ZqpUWap98zvmRUsbHUu6Rfa6M0prqEbmZdG3fguuqpRseXty6GmLl2wwPLt1jJSrv1rlyYcBUQexiQhgKjL2PGeKyhSqv7hYriLlMiy6XfRv7L2Q3uC7j17d-QK6nZ78nP-vLq9n55PSyBsVFU6NoXNNIHrhsAkhUXirPQXrjEYDeUXRGSKYENyYY0B5cCBI4hRBEkEYckG8b32WKzyvMg12U27HrXI9xlS0zjCmpBWUF_b5BIcWcEwa7TO3CpbVl1P6P0ZYY7WuMhT16sy3Pod-S77kV4GQDvLQdrj92sj_O5u-W9UbR5gH_bhUuPVlthFH2dj6zSt5Of138Gdux-Afa3Ixx</recordid><startdate>201509</startdate><enddate>201509</enddate><creator>Tomiki, Yuichi</creator><creator>Kawai, Masaya</creator><creator>Takehara, Kazuhiro</creator><creator>Tashiro, Yoshihiko</creator><creator>Munakata, Shinya</creator><creator>Kure, Kazumasa</creator><creator>Ishiyama, Shun</creator><creator>Sugimoto, Kiichi</creator><creator>Kamiyama, Hirohiko</creator><creator>Takahashi, Makoto</creator><creator>Sakamoto, Kazuhiro</creator><general>Blackwell Publishing Ltd</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201509</creationdate><title>Clinical pathway to discharge 3 days after colorectal endoscopic submucosal dissection</title><author>Tomiki, Yuichi ; Kawai, Masaya ; Takehara, Kazuhiro ; Tashiro, Yoshihiko ; Munakata, Shinya ; Kure, Kazumasa ; Ishiyama, Shun ; Sugimoto, Kiichi ; Kamiyama, Hirohiko ; Takahashi, Makoto ; Sakamoto, Kazuhiro</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5238-e38a8842f248fc4e5d45d2c4d7decc0b0ea734153277f7c6dcaff4c20cff3f473</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Aged</topic><topic>Area Under Curve</topic><topic>clinical pathway</topic><topic>Cohort Studies</topic><topic>Colonoscopy - adverse effects</topic><topic>Colonoscopy - methods</topic><topic>colorectal endoscopic submucosal dissection (ESD)</topic><topic>Colorectal Neoplasms - mortality</topic><topic>Colorectal Neoplasms - pathology</topic><topic>Colorectal Neoplasms - surgery</topic><topic>Confidence Intervals</topic><topic>Critical Pathways</topic><topic>Dissection - adverse effects</topic><topic>Dissection - methods</topic><topic>Female</topic><topic>hospital stay</topic><topic>Humans</topic><topic>incident</topic><topic>Intestinal Mucosa - pathology</topic><topic>Intestinal Mucosa - surgery</topic><topic>Length of Stay</topic><topic>Male</topic><topic>medical fee point</topic><topic>Middle Aged</topic><topic>Minimally Invasive Surgical Procedures - methods</topic><topic>Minimally Invasive Surgical Procedures - mortality</topic><topic>Odds Ratio</topic><topic>Patient Discharge - standards</topic><topic>Patient Discharge - trends</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>ROC Curve</topic><topic>Survival Rate</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tomiki, Yuichi</creatorcontrib><creatorcontrib>Kawai, Masaya</creatorcontrib><creatorcontrib>Takehara, Kazuhiro</creatorcontrib><creatorcontrib>Tashiro, Yoshihiko</creatorcontrib><creatorcontrib>Munakata, Shinya</creatorcontrib><creatorcontrib>Kure, Kazumasa</creatorcontrib><creatorcontrib>Ishiyama, Shun</creatorcontrib><creatorcontrib>Sugimoto, Kiichi</creatorcontrib><creatorcontrib>Kamiyama, Hirohiko</creatorcontrib><creatorcontrib>Takahashi, Makoto</creatorcontrib><creatorcontrib>Sakamoto, Kazuhiro</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Digestive endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tomiki, Yuichi</au><au>Kawai, Masaya</au><au>Takehara, Kazuhiro</au><au>Tashiro, Yoshihiko</au><au>Munakata, Shinya</au><au>Kure, Kazumasa</au><au>Ishiyama, Shun</au><au>Sugimoto, Kiichi</au><au>Kamiyama, Hirohiko</au><au>Takahashi, Makoto</au><au>Sakamoto, Kazuhiro</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical pathway to discharge 3 days after colorectal endoscopic submucosal dissection</atitle><jtitle>Digestive endoscopy</jtitle><addtitle>Digestive Endoscopy</addtitle><date>2015-09</date><risdate>2015</risdate><volume>27</volume><issue>6</issue><spage>679</spage><epage>686</epage><pages>679-686</pages><issn>0915-5635</issn><eissn>1443-1661</eissn><abstract>Background and Aim
Colorectal endoscopic submucosal dissection (ESD) is a useful treatment method; however, no index has been established for time for patient to start food ingestion or be discharged after ESD. We investigated the potential of a clinical pathway in which patients started food ingestion on day 2 after ESD and were discharged on day 3.
Methods
A total of 382 patients underwent colorectal ESD between 2006 and 2012. A flow chart of a clinical pathway was prepared based on the data obtained, with the aim of shortening hospital stay after ESD.
Results
Mean duration of postoperative hospital stay in the 382 patients was 5.3 ± 1.8 days. The most common cause of extended hospital stay was abnormal blood test finding, as detected in 50 patients in group C (n = 131; 38.2%), followed by careful course observations, as noted in 48 patients in group C (n = 131; 36.6%). Regarding procedural accidents as a result of ESD, intraoperative perforation occurred in 15 patients (3.9%) and post‐ESD bleeding in seven patients (1.8%), which extended the hospital stay. Food ingestion was started on day 2 when no abnormality was noted during ESD or in physical and imaging findings or blood tests on day 1. In the 86 patients who underwent the prepared clinical pathway as a validation study, 68 (79.0%) were discharged on day 3. Duration of postoperative hospital stay was 3.4 ± 1.2 days.
Conclusion
Discharge may be possible 3 days after ESD when no abnormalities are noted during ESD or on post‐ESD day 1.</abstract><cop>Australia</cop><pub>Blackwell Publishing Ltd</pub><pmid>25756606</pmid><doi>10.1111/den.12468</doi><tpages>8</tpages></addata></record> |
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| subjects | Aged Area Under Curve clinical pathway Cohort Studies Colonoscopy - adverse effects Colonoscopy - methods colorectal endoscopic submucosal dissection (ESD) Colorectal Neoplasms - mortality Colorectal Neoplasms - pathology Colorectal Neoplasms - surgery Confidence Intervals Critical Pathways Dissection - adverse effects Dissection - methods Female hospital stay Humans incident Intestinal Mucosa - pathology Intestinal Mucosa - surgery Length of Stay Male medical fee point Middle Aged Minimally Invasive Surgical Procedures - methods Minimally Invasive Surgical Procedures - mortality Odds Ratio Patient Discharge - standards Patient Discharge - trends Prognosis Retrospective Studies Risk Assessment ROC Curve Survival Rate Time Factors Treatment Outcome |
| title | Clinical pathway to discharge 3 days after colorectal endoscopic submucosal dissection |
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