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

Abstract

To evaluate the usefulness of this pathway in managing postoperative emptying failure as a secondary complication of radical hysterectomy. 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. Retrospective qualitative study. 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. Data from a total of 185 patients were analysed. Mean period of the indwelling catheter was 8·3 (SD 1·1), 13·0 (SD 1·1) and 13·1 (SD 3·3) 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 14·1 (SD 4·8), 20·2 (SD 10) and 18·2 (SD 8·8) days and the periods of time for the indwelling catheters were 8·31 (SD 1·1), 13·1 (SD 3·3) and 13·0 (SD 1·1) 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. Our results demonstrated that CP is an effective treatment modality for the management of postoperative emptying failure after radical hysterectomy. 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.