経尿道的前立腺切除術(TURP)に対する多施設共通クリニカルパスの進化  [in Japanese] EVOLUTION OF COMMON CLINICAL PATH FOR TRANSURETHRAL RESECTION OF PROSTATE (TURP)  [in Japanese]

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Abstract

(目的) 経尿道的前立腺切除術 (TURP) に対する共通クリニカルパスの改訂による, 複数の施設での周術期管理の改善度を検討する.<br>(対象と方法) 共通パスを用いた平成14年度の周術期管理を検討してパスの改訂を行い, そのパスに基づいて平成15年度に行われた周術期管理の変化と各年度の施設問差を検討した.<br>(結果) 各年度で, 年齢, 軽度日常生活動作障害・認知障害を有する患者の比率, 全身麻酔を受けた患者の比率, 手術時間, 切除重量, 術中合併症の発生率, 輸血率に差を認めなかった. 術前入院期間, 再入院率, 手術麻酔費にも有意差はなかったが, カテーテル抜去は2.9術後日から2.3術後日と有意に早くなり, 術後入院期間は7.7日から6.1日に有意に短縮され, 入院費総額は43,703点から39,661点に有意に減少した. 術後の発熱頻度は平成15年度に2.4%から11.2%に上昇したが, 術後精巣上体炎, 術後出血, 術後排尿困難の発生率, それらの対処方法に関しては両群間で差を認めなかった. 各施設とも, 平成15年度の術後入院期間は短縮, 入院費総額も減少し, 標準偏差も概ね縮小したが, 平成14年度に見られた施設間差は平成15年度にも認められた.<br>(考察) 複数の施設で共通パスを用いた周術期管理を検討し, パスの改訂を行うことにより, 施設間差はあるものの標準化が図れることがわかった. 共通パスは, 全国レベルでの標準化を進めるために有効であると考えられた.

(Objectives) Improvement of perioperative management for transurethral resection of the prostate (TURP) by revising the common clinical path was investigated in multiple hospitals.<br>(Methods) We discussed perioperative outcomes using the common path in 2002 and revised it for 2003. Changes in perioperative outcomes between 2002 and 2003 and differences among hospitals were compared.<br>(Results) There were no statistically significant differences in age, proportion of patients with mildly impaired activity of daily living and/or impaired cognition, general anesthesia, operating duration, resected weight, incidence of intraoperative complications and blood transfusion between 2002 and 2003. Although there were no differences in preoperative hospital stay, re-hospitalization rate and charges for surgery and anesthesia, Foley catheter was removed significantly earlier from postoperative day 2.9 to 2.3 and total medical charge significantly decreased from 43, 703 to 39, 661 units (1 unit=10 yen). The incidence of postoperative pyrexia increased from 2.4% to 11.2% in 2003, however, the incidences of epididymitis, postoperative bleeding and postoperative difficulty on micturition remained stable. The average and standard deviation of postoperative hospital stay and total medical charge at each hospital decreased, however, differences among hospitals found in 2002 remained in 2003.<br>(Conclusion) We found that standardization can be accomplished by discussing perioperative management using a common path in multiple hospitals and revising the path as needed. Common clinical path should be a valid method of advancing standardization in Japan.(Objectives) Improvement of perioperative management for transurethral resection of the prostate (TURP) by revising the common clinical path was investigated in multiple hospitals.<br>(Methods) We discussed perioperative outcomes using the common path in 2002 and revised it for 2003. Changes in perioperative outcomes between 2002 and 2003 and differences among hospitals were compared.<br>(Results) There were no statistically significant differences in age, proportion of patients with mildly impaired activity of daily living and/or impaired cognition, general anesthesia, operating duration, resected weight, incidence of intraoperative complications and blood transfusion between 2002 and 2003. Although there were no differences in preoperative hospital stay, re-hospitalization rate and charges for surgery and anesthesia, Foley catheter was removed significantly earlier from postoperative day 2.9 to 2.3 and total medical charge significantly decreased from 43, 703 to 39, 661 units (1 unit=10yen). The incidence of postoperative pyrexia increased from 2.4% to 11.2% in 2003, however, the incidences of epididymitis, postoperative bleeding and postoperative difficulty on micturition remained stable. The average and standard deviation of postoperative hospital stay and total medical charge at each hospital decreased, however, differences among hospitals found in 2002 remained in 2003.<br>(Conclusion) We found that standardization can be accomplished by discussing perioperative management using a common path in multiple hospitals and revising the path as needed. Common clinical path should be a valid method of advancing standardization in Japan.

Journal

  • The Japanese Journal of Urology

    The Japanese Journal of Urology 98(1), 3-8, 2007-01-15

    The Japanese Urological Association

References:  8

Cited by:  2

Codes

  • NII Article ID (NAID)
    110006164624
  • NII NACSIS-CAT ID (NCID)
    AN00196577
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    00215287
  • NDL Article ID
    8661629
  • NDL Source Classification
    ZS39(科学技術--医学--皮膚科学・泌尿器科学)
  • NDL Call No.
    Z19-203
  • Data Source
    CJP  CJPref  NDL  NII-ELS  J-STAGE 
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