title: Planned early discharge-elective surgical readmission pathway for patients with gallstone pancreatitis.
abstract: OBJECTIVE
  We assessed outcomes in patients with gallstone pancreatitis (GSP) managed using a readmission pathway of discharge from the index admission with early readmission cholecystectomy and compared these with conventional management. We hypothesized that the pathway would decrease hospital length of stay (LOS).
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  County-based academic center.
  
  
  METHODS
  All patients admitted with GSP between June 1, 2005, and June 30, 2007. The control group consisted of patients from the year before the adoption of the readmission pathway. The pathway group patients were enrolled in the first year from its inception (July 1, 2006).
  
  
  METHODS
  Overall LOS, time from admission until operation, and pathway failures.
  
  
  RESULTS
  Of 252 patients with GSP, 144 were managed by conventional methods, and 108 were managed using the readmission pathway. The overall mean (SD) LOS was 8.5 (6.0) days in the control group and 5.9 (3.1) days in the pathway group (P < .001). The mean (SD) times to surgery were 6.6 (4.5) days in the control group and 22.7 (10.4) days in the pathway group (P =.01). This did not lead to significantly more treatment failures, with 34 (23.6%) in the control group and 33 (30.6%) in the pathway group (P =.21). There were 6.5%(7 of 108) unplanned readmissions for recurrent pancreatitis in the pathway group. Morbidity was otherwise similar in both groups.
  
  
  CONCLUSIONS
  Use of the readmission pathway's early discharge protocol decreased overall LOS and in this study population was not associated with any increase in morbidity compared with conventional management.
authors.affiliation: Division of Emergency Surgery, Department of Surgery, Keck School of Medicine of University of Southern California and Los Angeles County-USC Medical Center, Los Angeles, CA 90033, USA.
authors.forename: Tatyan
authors.initials: T
authors.lastname: Clarke
authors.forename: Helen
authors.initials: H
authors.lastname: Sohn
authors.forename: Rebecca
authors.initials: R
authors.lastname: Kelso
authors.forename: Mikael
authors.initials: M
authors.lastname: Petrosyan
authors.forename: Shirin
authors.initials: S
authors.lastname: Towfigh
authors.forename: Rodney
authors.initials: R
authors.lastname: Mason
mesh_terms: D000328:Adult; D000465:Algorithms; D000556:Ambulatory Surgical Procedures; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002763:Cholecystectomy / Q000592:standards; D041761:Cholecystolithiasis / Q000150:complications; D019091:Critical Pathways; D005260:Female; D042882:Gallstones / Q000209:etiology; D006786:Hospitals, Urban; D006801:Humans; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000175:diagnosis / Q000601:surgery*; D010351:Patient Discharge; D010359:Patient Readmission; D011446:Prospective Studies; D012008:Recurrence