Influence of Clinical pathways on treatment and outcome quality for patients undergoing pancreatoduodenectomy? A retrospective cohort study
Summary: Background: Pancreatic surgery demands complex multidisciplinary management. Clinical pathways (CPs) are a tool to facilitate this task, but evidence for their utility in pancreatic surgery is scarce. This study evaluated the effect of CPs on quality of care for pancreatoduodenectomy. Meth...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2020-08-01
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| Series: | Asian Journal of Surgery |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1015958419308218 |
| _version_ | 1819230128398401536 |
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| author | Patrick Téoule Britta Kunz Matthias Schwarzbach Emrullah Birgin Felix Rückert Torsten J. Wilhelm Marco Niedergethmann Stefan Post Nuh N. Rahbari Christoph Reißfelder Ulrich Ronellenfitsch |
| author_facet | Patrick Téoule Britta Kunz Matthias Schwarzbach Emrullah Birgin Felix Rückert Torsten J. Wilhelm Marco Niedergethmann Stefan Post Nuh N. Rahbari Christoph Reißfelder Ulrich Ronellenfitsch |
| author_sort | Patrick Téoule |
| collection | DOAJ |
| description | Summary: Background: Pancreatic surgery demands complex multidisciplinary management. Clinical pathways (CPs) are a tool to facilitate this task, but evidence for their utility in pancreatic surgery is scarce. This study evaluated the effect of CPs on quality of care for pancreatoduodenectomy. Methods: Data of all consecutive patients who underwent pancreatoduodenectomy before (n = 147) or after (n = 148) CP introduction were evaluated regarding catheter and drain management, postoperative mobilization, pancreatic enzyme substitution, resumption of diet and length of stay. Outcome quality was assessed using glycaemia management, morbidity, mortality, reoperation and readmission rates. Results: Catheters and abdominal drainages were removed significantly earlier in patients treated with CP (p < 0.0001). First intake of liquids, nutritional supplement and solids was significantly earlier in the CP group (p < 0.0001). Exocrine insufficiency was significantly less common after CP implementation (47.3% vs. 69.7%, p < 0.0001). The number of patients receiving intraoperative transfusion dropped significantly after CP implementation (p = 0.0005) and transfusion rate was more frequent in the pre-CP group (p = 0.05). The median number of days with maximum pain level >3 was significantly higher in the CP group (p < 0.0001). There was no significant difference in mortality, morbidity, reoperation and readmission rates. Conclusions: Following implementation of a CP for pancreatoduodenectomy, several indicators of process and outcome quality improved, while others such as mortality and reoperation rates remained unchanged. CPs are a promising tool to improve quality of care in pancreatic surgery. |
| first_indexed | 2024-12-23T11:24:09Z |
| format | Article |
| id | doaj.art-ec062ea39710455db448f58c89addbaf |
| institution | Directory Open Access Journal |
| issn | 1015-9584 |
| language | English |
| last_indexed | 2024-12-23T11:24:09Z |
| publishDate | 2020-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Asian Journal of Surgery |
| spelling | doaj.art-ec062ea39710455db448f58c89addbaf2022-12-21T17:49:00ZengElsevierAsian Journal of Surgery1015-95842020-08-01438799809Influence of Clinical pathways on treatment and outcome quality for patients undergoing pancreatoduodenectomy? A retrospective cohort studyPatrick Téoule0Britta Kunz1Matthias Schwarzbach2Emrullah Birgin3Felix Rückert4Torsten J. Wilhelm5Marco Niedergethmann6Stefan Post7Nuh N. Rahbari8Christoph Reißfelder9Ulrich Ronellenfitsch10Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, GermanyDepartment of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, GermanyDepartment of General, Visceral, Vascular, and Thoracic Surgery, Klinikum Frankfurt Höchst, Frankfurt, GermanyDepartment of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, GermanyDepartment of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, GermanyDepartment of General and Visceral Surgery, GRN-Klinik Weinheim, Weinheim, GermanyDepartment of Surgery, Alfried Krupp Hospital, Essen, GermanyDepartment of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, GermanyDepartment of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, GermanyDepartment of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, GermanyDepartment of Visceral, Vascular and Endocrine Surgery, University Hospital Halle, Halle, Germany; Corresponding author. University Hospital Halle, Department of Visceral, Vascular and Endocrine Surgery, Ernst-Grube-Str.40, 06097 Halle, Germany.Summary: Background: Pancreatic surgery demands complex multidisciplinary management. Clinical pathways (CPs) are a tool to facilitate this task, but evidence for their utility in pancreatic surgery is scarce. This study evaluated the effect of CPs on quality of care for pancreatoduodenectomy. Methods: Data of all consecutive patients who underwent pancreatoduodenectomy before (n = 147) or after (n = 148) CP introduction were evaluated regarding catheter and drain management, postoperative mobilization, pancreatic enzyme substitution, resumption of diet and length of stay. Outcome quality was assessed using glycaemia management, morbidity, mortality, reoperation and readmission rates. Results: Catheters and abdominal drainages were removed significantly earlier in patients treated with CP (p < 0.0001). First intake of liquids, nutritional supplement and solids was significantly earlier in the CP group (p < 0.0001). Exocrine insufficiency was significantly less common after CP implementation (47.3% vs. 69.7%, p < 0.0001). The number of patients receiving intraoperative transfusion dropped significantly after CP implementation (p = 0.0005) and transfusion rate was more frequent in the pre-CP group (p = 0.05). The median number of days with maximum pain level >3 was significantly higher in the CP group (p < 0.0001). There was no significant difference in mortality, morbidity, reoperation and readmission rates. Conclusions: Following implementation of a CP for pancreatoduodenectomy, several indicators of process and outcome quality improved, while others such as mortality and reoperation rates remained unchanged. CPs are a promising tool to improve quality of care in pancreatic surgery.http://www.sciencedirect.com/science/article/pii/S1015958419308218Clinical pathwaysPancreatic surgeryPancreatoduodenectomyQuality of careOutcomes |
| spellingShingle | Patrick Téoule Britta Kunz Matthias Schwarzbach Emrullah Birgin Felix Rückert Torsten J. Wilhelm Marco Niedergethmann Stefan Post Nuh N. Rahbari Christoph Reißfelder Ulrich Ronellenfitsch Influence of Clinical pathways on treatment and outcome quality for patients undergoing pancreatoduodenectomy? A retrospective cohort study Asian Journal of Surgery Clinical pathways Pancreatic surgery Pancreatoduodenectomy Quality of care Outcomes |
| title | Influence of Clinical pathways on treatment and outcome quality for patients undergoing pancreatoduodenectomy? A retrospective cohort study |
| title_full | Influence of Clinical pathways on treatment and outcome quality for patients undergoing pancreatoduodenectomy? A retrospective cohort study |
| title_fullStr | Influence of Clinical pathways on treatment and outcome quality for patients undergoing pancreatoduodenectomy? A retrospective cohort study |
| title_full_unstemmed | Influence of Clinical pathways on treatment and outcome quality for patients undergoing pancreatoduodenectomy? A retrospective cohort study |
| title_short | Influence of Clinical pathways on treatment and outcome quality for patients undergoing pancreatoduodenectomy? A retrospective cohort study |
| title_sort | influence of clinical pathways on treatment and outcome quality for patients undergoing pancreatoduodenectomy a retrospective cohort study |
| topic | Clinical pathways Pancreatic surgery Pancreatoduodenectomy Quality of care Outcomes |
| url | http://www.sciencedirect.com/science/article/pii/S1015958419308218 |
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