Implementation of a 6‐day discharge pathway after gastric cancer surgery and perioperative rehabilitation

Abstract

Background
The clinical pathway（CP）of gastric cancer surgery at our institute was revised from a 7‐day discharge CP to a 6‐day discharge CP in October 2017. Perioperative rehabilitation was also implemented for elderly patients aged 65 years or older and patients who underwent proximal gastrectomy（PG）or total gastrectomy（TG）according to the ESSENSE concept. Perioperative rehabilitation consisted of preoperative orientation for the postoperative clinical course, rehabilitation and ambulation assistance on postoperative days 1‐3, and light‐load exercise using an ergometer on postoperative day 4 and thereafter．
Methods
The background characteristics, surgical factors, and postoperative clinical course were compared between the 7‐day discharge CP group（n＝112, consecutive patients who underwent gastrectomy at our institute between Apr 2017 and Sep 2017）and 6‐day discharge CP group（n＝142, between Oct 2017 and Mar 2018）．
Results
The laparoscopic approach was employed more often（81.3 vs. 92.3％，p＝0.012）and the operative time was significantly shorter（217 vs. 202 minutes, p＝0.020）in the 6‐day discharge CP group. The incidence of postoperative complications of Clavien‐Dindo classification grade II or higher was comparable between the 2 groups（5.4 vs. 5.6％，p＝0.92）and the postoperative length of stay was shorter in the 6‐day discharge CP group（7（6‐57）vs. 6（5‐42），p＜0.0001）．The unexpected re‐admission rate within 30 days after surgery did not increase in the 6‐day discharge CP group（3.8 vs. 2.1％，p＝0.48）．
Conclusions
A 6‐day discharge CP and perioperative rehabilitation for elderly and PG/TG patients who underwent gastric cancer surgery were safely implemented.