TY  - JOUR
A1  - Téoule, Patrick Sebastian
A1  - Kunz, Britta
A1  - Schwarzbach, Matthias
A1  - Birgin, Emrullah
A1  - Rückert, Felix
A1  - Wilhelm, Torsten
A1  - Niedergethmann, Marco
A1  - Post, Stefan
A1  - Rahbari, Nuh Nabi
A1  - Reißfelder, Christoph
A1  - Ronellenfitsch, Ulrich
T1  - Influence of clinical pathways on treatment and outcome quality for patients undergoing pancreatoduodenectomy? – a retrospective outcome cohort study
T2  - Asian journal of surgery
N2  - 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.
KW  - Clinical pathways
KW  - Pancreatic surgery
KW  - Pancreatoduodenectomy
KW  - Quality of care
KW  - Outcomes
Y1  - 2019
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/53418
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-534187
SN  - 0219-3108
SN  - 1015-9584
N1  - © 2019 Asian Surgical Association and Taiwan Robotic Surgery Association. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
VL  - 43
IS  - 8
SP  - 799
EP  - 809
PB  - Excerpta Medica Asia
CY  - Hong Kong
ER  -