Effect of the systematised critical pathway protocol on emptying failure as a secondary complication of radical hysterectomy due to uterine cervix cancer

Abstract

Aims and objectives To evaluate the usefulness of this pathway in managing postoperative emptying failure as a secondary complication of radical hysterectomy. Background Postoperative urological management after radical hysterectomy has not been effective. We designed and prospectively applied a critical pathway for effective postoperative urological management after radical hysterectomy, based on early catheter removal and application of clean intermittent catheterisation. Design Retrospective qualitative study. Materials and methods Retrospective review of results from a database of patients who underwent radical hysterectomy and pelvic lymphadenectomy for the treatment of uterine cervical cancer from 2004-2008 and analysis of questionnaires from ward nurses (Appendix 1) who were directly involved in patient care for measuring the clinical effectiveness. Results Data from a total of 185 patients were analysed. Mean period of the indwelling catheter was 8 center dot 3 (SD 1 center dot 1), 13 center dot 0 (SD 1 center dot 1) and 13 center dot 1 (SD 3 center dot 3) days in the critical pathway (CP), parallel control (PC) and historical control (HC) groups, respectively. Among CP, HC and PC groups, the overall hospital stays were 14 center dot 1 (SD 4 center dot 8), 20 center dot 2 (SD 10) and 18 center dot 2 (SD 8 center dot 8) days and the periods of time for the indwelling catheters were 8 center dot 31 (SD 1 center dot 1), 13 center dot 1 (SD 3 center dot 3) and 13 center dot 0 (SD 1 center dot 1) days, respectively. Significant differences in the overall hospital stay and the postoperative hospital stay were observed between CP group and the other groups. Analysis of the questionnaires showed that 67% of nurses agreed that the critical pathway was more effective than the previous management pathway system. Conclusions Our results demonstrated that CP is an effective treatment modality for the management of postoperative emptying failure after radical hysterectomy. Relevance to clinical practice Our critical pathway may be applicable to postoperative urological management of radical pelvic surgeries. It may help patients in understanding their hospital course of treatment and encourage patients to participate in their postoperative care.