• 作者：Cristina Sancho^a ; ^g ; ^{crisanmo10@hotmail.com} ; Francisco L. Villalba^a ; ^f ; ^g ; M. Jos&#233 ; Garcí ; a-Coret^a ; ^f ; ^g ; Antonio Vá ; zquez^a ; ^g ; M. Jos&#233 ; Safont^b ; ^g ; Ana Herná ; ndez^c ; ^g ; Encarnació ; n Martí ; nez^d ; ^g ; Vicente Martí ; nez-Sanjuá ; n^e ; ^g ; Juan Garcí ; a-Armengol^a ; ^g ; Jos&#233 ; V. Roig^a ; ^g
• 关键词：C&aacute ; ncer de recto ; V&iacute ; a cl&iacute ; nica ; Indicadores de calidad asistencial
• 刊名：Cirug铆a Espa帽ola
• 出版年：2010
• 期刊代码：pca87_0009739X
• 类别：med
• 出版时间：April 2010
• 卷：87
• 期：4
• 页码：231-238
• 文件大小：193 K

class="h4">Objectives

To analyse whether the self-evaluation of a clinical pathway improves the results of rectal cancer (RC) treatment.

class="h4">Patients and method

Patients operated on for RC were divided into 3 groups according to biannual modifications of a clinical pathway analysing several indicators.

class="h4">Results

166 patients: Group A: 2002 鈥?#xA0;3 n=50, B: 2004 鈥?#xA0;5 n=53 and C: 2006 鈥?#xA0;7 n=63, without any differences in age, gender or comorbidity. Preoperative study improved with the introduction of CT scan: 76%in Group C vs. 6%in Group A (P<0.001). All Group C tumours were staged using MR, rectal ultrasound or both, compared to 84%in Group A (P<0.001). The rate of abdominal-perineal resections was reduced from 42%(Group A) to 17%(Group C); (P=0.007) and about 48%of surgeons in Group A vs. 94%in the C had a specific activity in coloproctology (P<0.001). The average lymph node count was: Group A=6.2卤4.5 vs. 13卤6.5 in the C and circumferential margin analysis was reported in 24%of Group A vs. 76%in Group C (P<0.001). Parameters such as perioperative blood transfusion, ICU admission, use of nasogastric tube, early feeding or epidural analgesia also improved progressively. Operative mortality decreased non-significantly to 4.7%and anastomotic leaks from 24%to 9.5%with a reduction in postoperative stay from 15 to 11 days during the period analysed (P=0.029).

class="h4">Conclusions

Several indicators have significantly improved in a relatively short period of time due to self-evaluations of the process.