Abstract
In this study, we tried to change the duration of postoperative prophylactic medication of antibiotics from three days to only one day in our critical pathway for total gastrectomy, and the kind of antibiotic from Flomoxf (FMOX) to Cefazolin (CEZ). The propriety of critical pathway was evaluated in terms of postoperative complications, especially infection. [Patients and method] Therewere three groups such as group A, Group B and group C. Group A consisted of 75 patients who received FMOX for four days, from operative day to the third postoperative day after total gastrectomy. Group B consisted of 59 patients who received FMOX in the operative day alone, and group C consisted of 25 patients who received CEZ in the operative day alone. In each group, the antibiotic of 1g was medicated in drip infusion twice on the operative day before and after surgery. Furthermore, group A was added intravenous infusion of 1g FMOX twice a day for three days. [Results] 1. There were no statistical difference about the incidence of post-operative complications and infections among three groups. But the incidence of 52% was highest in the group C. 2. There was little difference about the change of fever pattern for three days after surgery. After 4th day, the number of patients with fever more than 37.5°C was 68% in group B, and there was a significant difference between group A and group B. 3. In the clonological change of WBC and CRP as a laboratory data, there was any difference in WBC between three groups but CRP was higher in the group C. [Conclusion] The prophylactic CEZ oneday medication in the critical path for the total gastrectomy was judged to be clinically acceptable, though the incidence of post-operative complications tended to be slightly high.
