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[Effect of a clinical pathway in patients with Crohn's disease complicated with intestinal obstruction]
Zhen Guo, Lei Cao, Jianfeng Gong
1Department of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China. juwiming@nju.edu.cn.
Insights
A clinical pathway for Crohn disease (CD) with intestinal obstruction improved patient outcomes. This approach reduced hospital stays, costs, and readmissions for surgical patients.
Area of Science:
- Gastroenterology
- Surgical Outcomes
- Health Services Research
Background:
- Crohn disease (CD) can lead to intestinal obstruction, a serious complication requiring medical and surgical management.
- Standardized treatment protocols may optimize care for complex CD cases.
Purpose of the Study:
- To evaluate the effectiveness of a clinical pathway (CP) for managing Crohn disease patients experiencing intestinal obstruction.
Main Methods:
- A retrospective study comparing 119 CD patients treated with a CP (CP group) against 108 patients managed conventionally (non-CP group).
- Key outcomes assessed included operation rates, stoma rates, surgical complication morbidity, hospital stay duration, hospital costs, and 6-month unplanned readmission rates.
Main Results:
- While operation, stoma, and complication rates were similar between groups, the CP group showed significantly shorter postoperative hospital stays (10.9 vs. 13.2 days).
- The CP group also incurred lower mean hospital costs (78,325 vs. 85,310 Yuan) and had a reduced rate of 6-month unplanned readmissions (3.4% vs. 11.1%).
Conclusions:
- Implementing a clinical pathway for Crohn disease with intestinal obstruction effectively reduces postoperative hospital stay and hospital costs.
- This standardized approach also significantly lowers the rate of 6-month unplanned readmissions in patients requiring surgery.
Objective:
To evaluate the effect of a clinical pathway for Crohn disease (CD) complicated with intestinal obstruction.
Methods:
CD patients complicated with intestinal obstruction in Inflammatory Bowel Disease(IBD) Center of Jinling Hospital were enrolled. One hundred and nineteen CD patients from March 2014 to September 2015 received treatment with the clinical pathway (CP), which was developed based on medical evidence and experience of the IBD center in February 2014, as CP group. The other 108 CD patients from September 2012 to February 2014 received treatment according to the management strategy made by individual attending physician as non-CP group. Rate of operation, rate of stoma, morbidity of surgical complications, hospital stay, hospital cost, and 6-month unplanned re-admission were compared between two groups.
Results:
The baseline data were similar between the two group (all P > 0.05). No significant differences were noted between these the two groups in terms of rate of operation (73.9% vs. 77.8%, P = 0.605), rate of stoma (15.9% vs. 25.0%, P = 0.197), and morbidity of surgical complications (23.9% vs. 27.4%, P = 0.724). However, the mean postoperative hospital stay was shorter (10.9 d vs. 13.2 d, P = 0.000), the mean hospital cost was less (78 325 Yuan vs. 85 310 Yuan, P = 0.031) and the rate of 6-month unplanned re-admission was lower(3.4% vs. 11.1%, P = 0.035) in CP group.
Conclusion:
Treatment based on this CP for CD patients complicated with intestinal obstruction can reduce the rate of 6-month unplanned re-admission, shorten the postoperative hospital stay and decrease the hospital cost in patients requiring surgery.
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