Influence of Clinical pathways on treatment and outcome quality for patients undergoing pancreatoduodenectomy? A retrospective cohort study

• Main Authors: Patrick Téoule, Britta Kunz, Matthias Schwarzbach, Emrullah Birgin, Felix Rückert, Torsten J. Wilhelm, Marco Niedergethmann, Stefan Post, Nuh N. Rahbari, Christoph Reißfelder, Ulrich Ronellenfitsch
• Format: Article
• Language: English
• Published: Elsevier 2020-08-01
• Series: Asian Journal of Surgery
• Subjects: Clinical pathways; Pancreatic surgery; Pancreatoduodenectomy; Quality of care; Outcomes
• Online Access: http://www.sciencedirect.com/science/article/pii/S1015958419308218

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.