Association of surgical care practices with length of stay and use of clinical protocols after elective bowel resection: results of a national survey

Am J Surg. 2010 Mar;199(3):299-304; discussion 304. doi: 10.1016/j.amjsurg.2009.08.027.


Background: Although management techniques have been proposed to accelerate gastrointestinal recovery after elective bowel resection (BR), most data are derived from single-institution experience. This study assessed the current state of perioperative care for elective BRs and the effect of pathway components on length of stay.

Methods: A web-based survey was conducted among surgeons regarding their last elective BR.

Results: Among 207 general and 200 colorectal surgeons, 30% practice in hospitals with a perioperative surgical care pathway intended to accelerate gastrointestinal recovery. Pathway components included early ambulation, early diet progression, early nasogastric tube removal/avoidance, and opioid-sparing pain control. Care practices associated with decreased length of stay included laparoscopic technique, early mobilization, early liquids, and antiemetic use to prevent symptoms associated with prolonged postoperative ileus.

Conclusions: Few hospitals have pathways but most surgeons likely would implement nationally endorsed guidelines. These data, along with other studies, may lead to well-accepted BR care pathways.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Clinical Protocols*
  • Colorectal Surgery*
  • Critical Pathways
  • Elective Surgical Procedures*
  • Female
  • General Surgery*
  • Humans
  • Intestinal Diseases / surgery*
  • Length of Stay / statistics & numerical data*
  • Male
  • Middle Aged
  • Postoperative Care*
  • Practice Patterns, Physicians'*