title: A 6-day clinical pathway after a pancreaticoduodenectomy is feasible, safe and efficient.
abstract: BACKGROUND
  The utilization of post-operative clinical pathways leads to shorter hospital stays and decreased healthcare costs. This study evaluated patient outcomes after implementation of a 6-day discharge pathway after a pancreaticoduodenectomy.
  
  
  METHODS
  A post-operative clinical pathway was developed and implemented for patients undergoing a pancreaticoduodenectomy at the present institution aimed at discharge by post-operative day six. Patient charts were retrospectively reviewed to determine the rates of adherence to the pathway at each step, readmission and post-operative complications.
  
  
  RESULTS
  In total, 113 consecutive patients underwent a pancreaticoduodenectomy, receiving post-operative care under the clinical pathway guidelines. The median length of stay was 7 days (mode 6 days); 41% of patients were discharged by post-operative day six, 62% by day seven and 79% by day eight. In univariate analysis, delayed gastric emptying was associated with a delayed discharge after post-operative day six (P = 0.002). There were no post-operative deaths and 16% of patients required readmission within 30 days of discharge. In univariate analysis, obesity was the only variable associated with an increased rate of readmission (P < 0.001).
  
  
  CONCLUSIONS
  Clinical pathway utilization after a pancreaticoduodenectomy allows a high percentage of patients to be discharged within a week and is associated with a low rate of readmission. Clinical pathway implementation allows for safe and efficient patient care.
authors: Department of Surgery, The University of Virginia, Charlottesville, VA 22908, USA.
authors: Dustin M
authors: DM
authors: Walters
authors: Patrick
authors: P
authors: McGarey
authors: Damien J
authors: DJ
authors: LaPar
authors: Aimee
authors: A
authors: Strong
authors: Elizabeth
authors: E
authors: Good
authors: Reid B
authors: RB
authors: Adams
authors: Todd W
authors: TW
authors: Bauer
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D019091:Critical Pathways / Q000592:standards; D005240:Feasibility Studies; D005260:Female; D018589:Gastroparesis / Q000209:etiology / Q000628:therapy; D019983:Guideline Adherence; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000592:standards; D010351:Patient Discharge; D010359:Patient Readmission; D011182:Postoperative Care; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome