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

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

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Division of Colorectal Surgery, University Hospitals Case Medical Center, 11100 Euclid Ave., Cleveland, OH 44106-5047, USA.



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.


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


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.


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.

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