The impact of a clinical pathway on patient postoperative recovery following pancreaticoduodenectomy

Amélie Tremblay St-Germain; Katharine S Devitt; Daniel J Kagedan; Beverly Barretto; Stephanie Tung; Steven Gallinger; Alice C Wei

doi:10.1016/j.hpb.2017.04.015

The impact of a clinical pathway on patient postoperative recovery following pancreaticoduodenectomy

HPB (Oxford). 2017 Sep;19(9):799-807. doi: 10.1016/j.hpb.2017.04.015. Epub 2017 Jun 1.

Authors

Amélie Tremblay St-Germain¹, Katharine S Devitt², Daniel J Kagedan³, Beverly Barretto², Stephanie Tung⁴, Steven Gallinger⁵, Alice C Wei⁶

Affiliations

¹ Department of Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
² Department of Surgery, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
³ Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.
⁴ Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
⁵ Department of Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; Department of Surgery, Toronto General Hospital, University Health Network, Toronto, ON, Canada; Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
⁶ Department of Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; Department of Surgery, Toronto General Hospital, University Health Network, Toronto, ON, Canada; Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada. Electronic address: alice.wei@uhn.ca.

PMID: 28578825
DOI: 10.1016/j.hpb.2017.04.015

Abstract

Background: Pancreaticoduodenectomies (PD) are complex surgical procedures. Clinical pathways (CPW) are surgical process improvement tools that guide postoperative recovery and are associated with high quality care. Our objective was to report the quality of surgical care following implementation of a CPW.

Methods: We developed and implemented a CPW for patients undergoing PD at a single high volume hepato-pancreato-biliary (HPB) centre. Patient outcomes were collected prospectively during the implementation period. A comparator cohort was selected by identifying patients that underwent a PD prior to CPW development.

Results: 122 patients underwent a PD during the CPW implementation period; 83 patients were initiated on the CPW. 74 patients underwent PD during the 12-month period prior to the CPW. The median hospital stay decreased after the implementation of the CPW (11 vs 8 days, p < 0.01) with no significant changes to mortality, morbidity, reoperation, or readmission rates. In-hospital complications were significantly higher in patients that were not initiated on the CPW (54% vs 74%, p = 0.03).

Conclusion: Results suggest the CPW reduced variability and allowed a greater proportion of patients to receive all elements of care, resulting in improved quality and efficiency of care based on current best evidence recommendations.

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Critical Pathways* / standards
Female
Hospital Mortality
Humans
Length of Stay
Male
Middle Aged
Pancreaticoduodenectomy / adverse effects
Pancreaticoduodenectomy / rehabilitation*
Pancreaticoduodenectomy / standards
Patient Readmission
Postoperative Complications / etiology
Postoperative Complications / surgery
Program Evaluation
Quality Improvement / standards*
Quality Indicators, Health Care* / standards
Recovery of Function
Reoperation
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome
Young Adult