Combined use of advanced practice providers and care pathways reduces the duration of stay after surgery for gastrointestinal malignancies

Surgery. 2021 Apr;169(4):852-858. doi: 10.1016/j.surg.2020.06.015. Epub 2020 Jul 23.


Background: The gastrointestinal surgical oncology service at our comprehensive cancer center sought to improve the quality of postsurgical inpatient care while increasing discharge efficiency.

Methods: A stakeholder team established standard postsurgical care pathways and dedicated inpatient advanced practice provider positions. We compared postsurgical length of stay before (July 2017 to April 2018) and after (May 2018 to April 2019) the interventions using Wilcoxon rank-sum tests. We benchmarked length of stay to National Surgical Quality Improvement Project and Centers for Medicare and Medicaid Services geometric mean length of stay. We also compared readmission rates and surgeon-specific Hospital Consumer Assessment of Health Care Provider and Systems and Press-Ganey scores.

Results: There were 462 cases before and 563 after the interventions. Postintervention, median length of stay decreased from 6.50 to 6.00 days (P = .017). There was a ≥1-day reduction for 10 of 14 case types with significant length of stay decreases for robotic esophagectomy (P = .001), liver resection (P = .023), and cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (P = .030). More case types met or exceeded Centers for Medicare and Medicaid Services and National Surgical Quality Improvement Project benchmarks after the interventions. Readmission rates were stable (preintervention 9.3%, postintervention 10.3%, P = .585). Press-Ganey and HCAHPS measures were stable or improved in all evaluated domains.

Conclusion: Incorporating advanced practice providers and care pathways into gastrointestinal surgical oncology inpatient care was associated with reduced length of stay without declination in readmission rates or patient experience measures.

MeSH terms

  • Clinical Competence* / standards
  • Critical Pathways*
  • Digestive System Surgical Procedures / adverse effects
  • Digestive System Surgical Procedures / methods
  • Disease Management
  • Gastrointestinal Neoplasms / diagnosis
  • Gastrointestinal Neoplasms / epidemiology*
  • Gastrointestinal Neoplasms / surgery
  • Health Personnel* / standards
  • Humans
  • Length of Stay / statistics & numerical data*
  • Medical Oncology / standards
  • Quality Assurance, Health Care
  • Quality Improvement