BACKGROUND: Evidence-based guidelines recommend cholecystectomy during initial hospitalization for complicated gallstone disease. Previous studies and quality initiative data from our institution demonstrated that only 40% to 75% of patients underwent cholecystectomy on index admission. STUDY DESIGN: In January 2009, we implemented a critical pathway to improve cholecystectomy rates for all patients emergently admitted for acute cholecystitis, mild gallstone pancreatitis, or common bile duct stones. We compared cholecystectomy rates during initial hospitalization, time to cholecystectomy, length of initial stay, and readmission rates in prepathway (January 2005 to February 2008) and postpathway patients (January 2009 to May 2010). RESULTS: Demographic and clinical characteristics were similar between prepathway (n = 455) and postpathway patients (n = 112). Cholecystectomy rates during initial hospitalization increased from 48% to 78% after pathway implementation (p < 0.0001). There were no differences in operative mortality or operative complications between the 2 groups. For patients undergoing cholecystectomy on initial hospitalization, the mean length of stay decreased after pathway implementation (7.1 days to 4.5 days; p < 0.0001), primarily due to a decrease in the time from admission to cholecystectomy (4.1 days to 2.1 days; p < 0.0001). Thirty-three percent of prepathway and 10% of postpathway patients required readmission for gallstone-related problems or operative complications (p < 0.0001), and each readmission generated an average of $19,000 in additional charges. CONCLUSIONS: Implementation of a multidisciplinary critical pathway improved cholecystectomy rates on initial hospitalization and lowered costs by shortening length of stay and markedly decreasing readmission rates for gallstone-related problems. Broader implementation of similar pathways offers the potential to translate evidence-based guidelines into clinical practice and minimize the cost of medical care.
BACKGROUND: Evidence-based guidelines recommend cholecystectomy during initial hospitalization for complicated gallstone disease. Previous studies and quality initiative data from our institution demonstrated that only 40% to 75% of patients underwent cholecystectomy on index admission. STUDY DESIGN: In January 2009, we implemented a critical pathway to improve cholecystectomy rates for all patients emergently admitted for acute cholecystitis, mild gallstone pancreatitis, or common bile duct stones. We compared cholecystectomy rates during initial hospitalization, time to cholecystectomy, length of initial stay, and readmission rates in prepathway (January 2005 to February 2008) and postpathway patients (January 2009 to May 2010). RESULTS: Demographic and clinical characteristics were similar between prepathway (n = 455) and postpathway patients (n = 112). Cholecystectomy rates during initial hospitalization increased from 48% to 78% after pathway implementation (p < 0.0001). There were no differences in operative mortality or operative complications between the 2 groups. For patients undergoing cholecystectomy on initial hospitalization, the mean length of stay decreased after pathway implementation (7.1 days to 4.5 days; p < 0.0001), primarily due to a decrease in the time from admission to cholecystectomy (4.1 days to 2.1 days; p < 0.0001). Thirty-three percent of prepathway and 10% of postpathway patients required readmission for gallstone-related problems or operative complications (p < 0.0001), and each readmission generated an average of $19,000 in additional charges. CONCLUSIONS: Implementation of a multidisciplinary critical pathway improved cholecystectomy rates on initial hospitalization and lowered costs by shortening length of stay and markedly decreasing readmission rates for gallstone-related problems. Broader implementation of similar pathways offers the potential to translate evidence-based guidelines into clinical practice and minimize the cost of medical care.
Authors: J F Calland; K Tanaka; E Foley; V E Bovbjerg; D W Markey; S Blome; J S Minasi; J B Hanks; M M Moore; J S Young; R S Jones; B D Schirmer; R B Adams Journal: Ann Surg Date: 2001-05 Impact factor: 12.969
Authors: Waldemar Uhl; Andrew Warshaw; Clement Imrie; Claudio Bassi; Colin J McKay; Paul G Lankisch; Ross Carter; Eugene Di Magno; Peter A Banks; David C Whitcomb; Christos Dervenis; Charles D Ulrich; Kat Satake; Paula Ghaneh; Werner Hartwig; Jens Werner; Gerry McEntee; John P Neoptolemos; Markus W Büchler Journal: Pancreatology Date: 2002 Impact factor: 3.996
Authors: Djemila Boerma; Erik A J Rauws; Yolande C A Keulemans; Ignace M C Janssen; Clemens J M Bolwerk; Ron Timmer; Egge J Boerma; Huug Obertop; Kees Huibregtse; Dirk J Gouma Journal: Lancet Date: 2002-09-07 Impact factor: 79.321
Authors: Jaime Benarroch-Gampel; Casey A Boyd; Kristin M Sheffield; Courtney M Townsend; Taylor S Riall Journal: J Am Coll Surg Date: 2011-08-20 Impact factor: 6.113
Authors: Marc D Trust; Kristin M Sheffield; Casey A Boyd; Jaime Benarroch-Gampel; Dong Zhang; Courtney M Townsend; Taylor S Riall Journal: Surgery Date: 2011-09 Impact factor: 3.982
Authors: Taylor P Williams; Francesca M Dimou; Deepak Adhikari; Thomas D Kimbrough; Taylor S Riall Journal: J Surg Res Date: 2015-04-16 Impact factor: 2.192