A 6-day clinical pathway after a pancreaticoduodenectomy is feasible, safe and efficient

作者：Walters Dustin M; McGarey Patrick; LaPar Damien J; Strong Aimee; Good Elizabeth; Adams Reid B; Bauer Todd W^*

来源：Hepato Pancreato Biliary, 2013, 15(9): 668-673.

DOI：10.1111/hpb.12016

Background: The utilization of post-operative clinical pathways leads to shorter hospital stays and decreased healthcare costs. This study evaluated patient outcomes after implementation of a 6-day discharge pathway after a pancreaticoduodenectomy.
Methods: A post-operative clinical pathway was developed and implemented for patients undergoing a pancreaticoduodenectomy at the present institution aimed at discharge by post-operative day six. Patient charts were retrospectively reviewed to determine the rates of adherence to the pathway at each step, readmission and post-operative complications.
Results: In total, 113 consecutive patients underwent a pancreaticoduodenectomy, receiving postoperative care under the clinical pathway guidelines. The median length of stay was 7 days (mode 6 days); 41% of patients were discharged by post-operative day six, 62% by day seven and 79% by day eight. In univariate analysis, delayed gastric emptying was associated with a delayed discharge after postoperative day six (P = 0.002). There were no post-operative deaths and 16% of patients required readmission within 30 days of discharge. In univariate analysis, obesity was the only variable associated with an increased rate of readmission (P < 0.001).
Discussion: Clinical pathway utilization after a pancreaticoduodenectomy allows a high percentage of patients to be discharged within a week and is associated with a low rate of readmission. Clinical pathway implementation allows for safe and efficient patient care.

• 出版日期2013-9