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

Abstract

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.

Impact of Enhanced Recovery After Surgery on Postoperative Recovery for Pancreaticoduodenectomy: Pooled Analysis of Observational Study

“…The characteristics of the 19 included articles, which comprised 7 cohort studies (8, 23–28) and 12 case-control studies (7, 29–39), are shown in Table 1, which totally contains 3387 patients. Thirteen studies (8, 23, 26, 28–34, 37–39) included patients undergoing PD, one study (35) included patients undergoing distal pancreatectomy (DP), one study (25) included patients undergoing proximal pancreatic resection, one study (36) included patients undergoing laparoscopic pancreatoduodenectomy (LDP), and three studies (7, 24, 27) included patients undergoing two forms of pancreatectomy.…”

“…Sixteen studies (7, 8, 23–25, 28–32, 34–39) reported mortality as the primary outcome (Figure 5). The OR for mortality was 0.96 (95% CI: 0.59 to 1.55).…”

“…Reoperation data were shown in 8 studies (7, 23, 24, 28–31, 39). We found no evidence that reoperation (Figure 7) performed significantly differently between the two groups in the fixed effect model (OR = 0.82; 95% CI: 0.55 to 1.21).…”

“…Meta-analysis including 1,087 patients showed that patients in the ERAS group had a shorter postoperative LOS than those in the conventional group (MD = −4.60 days; 95% CI: −5.85 to −3.36), although a moderate degree of heterogeneity was observed ( I 2 = 55%, P = 0.02). Ten studies (7, 24–26, 28, 31, 34, 35, 37, 39) provided the data total LOS. The estimated mean for the meta-analysis of these studies was −3.12 days (95% CI: −4.81 to −1.42), indicating a significant reduction in the mean of total LOS for the ERAS patients compared with the conventional group.…”

<p>Clinical Pathways For Pancreatic Surgery: Are They A Suitable Instrument For Process Standardization To Improve Process And Outcome Quality Of Patients Undergoing Distal And Total Pancreatectomy? - A Retrospective Cohort Study</p>

“…CPs have shown favorable perioperative results for a number of operations in gastrointestinal surgery 10. Kennedy et al (2012), Walters et al (2012) and Van der Kolk et al (2017) evaluated CPs for pancreaticoduodenectomy 11–13. All showed a reduction in length of stay and Kennedy et al additionally reported a non-significant decrease of overall complication rates.…”