A standardized care plan is associated with shorter hospital length of stay in patients undergoing pancreaticoduodenectomy

Nussbaum, Daniel P.; Penne, Kara; Stinnett, Sandra S.; Speicher, Paul J.; Cocieru, Andrei; Blazer, Dan G.; Zani, Sabino; Clary, Bryan M.; Tyler, Douglas S.; White, Rebekah R.

doi:10.1016/j.jss.2014.06.036

Cited by 51 publications

(45 citation statements)

References 35 publications

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“…This issue too remains somewhat unproven but is an important consideration given the dismal outcomes with surgery alone for this disease[23,45-47]. …”

Section: Resultsmentioning

confidence: 99%

Contemporary review of minimally invasive pancreaticoduodenectomy

Dai

Turley

Blazer

2016

WJGS

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AIMTo assess the current literature describing various minimally invasive techniques for and to review short-term outcomes after minimally invasive pancreaticoduodenectomy (PD).METHODSPD remains the only potentially curative treatment for periampullary malignancies, including, most commonly, pancreatic adenocarcinoma. Minimally invasive approaches to this complex operation have begun to be increasingly reported in the literature and are purported by some to reduce the historically high morbidity of PD associated with the open technique. In this systematic review, we have searched the literature for high-quality publications describing minimally invasive techniques for PD-including laparoscopic, robotic, and laparoscopic-assisted robotic approaches (hybrid approach). We have identified publications with the largest operative experiences from well-known centers of excellence for this complex procedure. We report primarily short term operative and perioperative results and some short term oncologic endpoints.RESULTSMinimally invasive techniques include laparoscopic, robotic and hybrid approaches and each of these techniques has strong advocates. Consistently, across all minimally invasive modalities, these techniques are associated less intraoperative blood loss than traditional open PD (OPD), but in exchange for longer operating times. These techniques are relatively equivalent in terms of perioperative morbidity and short term oncologic outcomes. Importantly, pancreatic fistula rate appears to be comparable in most minimally invasive series compared to open technique. Impact of minimally invasive technique on length of stay is mixed compared to some traditional open series. A few series have suggested that initiation of and time to adjuvant therapy may be improved with minimally invasive techniques, however this assertion remains controversial. In terms of short-terms costs, minimally invasive PD is significantly higher than that of OPD.CONCLUSIONMinimally invasive approaches to PD show great promise as a strategy to improve short-term outcomes in patients undergoing PD, but the best results remain isolated to high-volume centers of excellence.

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“…This issue too remains somewhat unproven but is an important consideration given the dismal outcomes with surgery alone for this disease[23,45-47]. …”

Section: Resultsmentioning

confidence: 99%

Contemporary review of minimally invasive pancreaticoduodenectomy

Dai

Turley

Blazer

2016

WJGS

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“…18 A standardized care plan for pancreaticoduodenectomy patients was retrospectively studied in another study focussing on predictors of LOS in-hospital. 15 Specific ERAS pathways, without PACU/ICU periods involved, focussed on in-hospital LOS, outcome mortality and morbidity. While these were unchanged, measurement of protocol adherence was not part of the study.…”

Section: Discussionmentioning

confidence: 99%

“…[15][16][17][18][19] In these care plans, a reduction of hospital length of stay (LOS), morbidity or mortality was not always observed. Crucially, the ICU period of these patients was not integrated in these protocols.…”

Section: Introductionmentioning

confidence: 99%

Implementation and Evaluation of a Clinical Pathway for Pancreaticoduodenectomy Procedures: a Prospective Cohort Study

Kolk

Boogaard

Becking-Verhaar

et al. 2017

Journal of Gastrointestinal Surgery

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Introduction Medical and nursing protocols in perioperative care for pancreaticoduodenectomy are mainly mono-disciplinary, limiting their integration and transparency in a continuous health care system. The aims of this study were to evaluate adherence to a multidisciplinary clinical pathway for all pancreaticoduodenectomy patients during their entire hospital stay and to determine if the use of this clinical pathway is associated with beneficial effects on clinical end points. Materials and Methods A prospective cohort study was conducted in 95 pancreaticoduodenectomy patients treated according to a clinical pathway, including a variance report, compared to a historical control group (n = 52) with a traditional treatment regime. Results Process evaluation of the clinical pathway group revealed that protocol adherence throughout all units was above 80%. Major complications according to Clavien-Dindo classification grade ≥3 decreased from 27 to 13%; p = 0.02. Hospital length of stay was significantly shorter in the clinical pathway group, median 10 days ], compared with the control group, median 13 days ; p = 0.02. Conclusion The use of a clinical pathway in pancreaticoduodenectomy patients was associated with high protocol adherence, improved outcome and shorter hospital length of stay. Variance report analysis and protocol adherence with a Prepare-ActReflect Cycle are essential in surveillance of outcome.

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“…La causa má s frecuente es la presencia de una fístula pancreá tica, aunque tambié n se han propuesto otras causas como la disminució n de la motilina plasmá tica tras la resecció n duodenal y una posible denervació n vagal por la disecció n y la linfadenectomías del ligamento hepatoduodenal y tronco celíaco 5 . La incidencia de VGL en nuestro estudio fue menor en el grupo de RMP (6,6 vs. 2,4%), en consonancia con los trabajos en los que se aplica este protocolo 5,15,32 . Las ú nicas medidas específicas que asociamos para disminuir la incidencia de VGL fueron la ingesta oral precoz y la realizació n de la gastroyeyunostomía de forma antecó lica, descrita previamente por el grupo de Heidelberg 5 .…”

Section: Discusió Nunclassified

“…La disminució n de la estancia hospitalaria es uno de los indicadores má s importantes de los programas de RMP 14,15,19,32 . En el presente estudio, la aplicació n de este programa permitió disminuir la estancia hospitalaria de manera significativa (18,7 vs. 14 días).…”

Section: Discusió Nunclassified