Amélie Tremblay St-Germain1, Katharine S Devitt2, Daniel J Kagedan3, Beverly Barretto2, Stephanie Tung4, Steven Gallinger5, Alice C Wei6. 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.
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.
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.
Authors: Maria Gómez; Cesar E Izquierdo; Victor Mayoral Rojals; Joseph Pergolizzi; Ricardo Plancarte Sanchez; Antonella Paladini; Giustino Varrassi Journal: Cureus Date: 2022-04-02