title: A standardized care plan is associated with shorter hospital length of stay in patients undergoing pancreaticoduodenectomy.
abstract: BACKGROUND
  In this retrospective review, we evaluate a standardized care plan (SCP) for patients undergoing pancreaticoduodenectomy, which included selective placement of feeding jejunostomy tubes (FJTs) and a perioperative fast-track recovery pathway (FTRP).
  
  
  METHODS
  A review of 242 patients undergoing pancreaticoduodenectomy was completed. Patients treated pre- and post-SCP implementation were compared. Univariate comparison followed by multivariable linear regression were performed to identify predictors of hospital length of stay (HLOS).
  
  
  RESULTS
  SCP patients (n = 100) were slightly older but otherwise similar to pre-SCP patients (n = 142). FJT placement occurred less frequently in SCP patients (38 versus 94%, P < 0.001). All SCP patients were initiated on the FTRP. Among SCP patients, an oral diet was introduced earlier (5 versus 8.5 d, P < 0.001) and HLOS was shorter (11 versus 13 d, P = 0.015). Readmission rates were similar. Following adjustment with linear regression, we confirmed SCP status as a predictor of HLOS. To assess SCP components, HLOS was evaluated separately based on FTRP status and FJT placement. Although both were highly associated with HLOS, neither was independently predictive in multivariable analysis.
  
  
  CONCLUSIONS
  Implementation of an SCP resulted in shorter HLOS without an increase in readmissions. Future studies are necessary to identify specific components of SCPs that most influence outcomes.
authors: Department of Surgery, Duke University, Durham, North California. Electronic address: daniel.nussbaum@duke.edu.
authors: Daniel P
authors: DP
authors: Nussbaum
authors: Department of Surgery, Duke University, Durham, North California.
authors: Kara
authors: K
authors: Penne
authors: Department of Biostatistics and Bioinformatics, Duke University, Durham, North California.
authors: Sandra S
authors: SS
authors: Stinnett
authors: Department of Surgery, Duke University, Durham, North California.
authors: Paul J
authors: PJ
authors: Speicher
authors: Department of Surgery, Duke University, Durham, North California.
authors: Andrei
authors: A
authors: Cocieru
authors: Department of Surgery, Duke University, Durham, North California.
authors: Dan G
authors: DG
authors: Blazer
authors: Department of Surgery, Duke University, Durham, North California.
authors: Sabino
authors: S
authors: Zani
authors: Department of Surgery, Duke University, Durham, North California.
authors: Bryan M
authors: BM
authors: Clary
authors: Department of Surgery, Duke University, Durham, North California.
authors: Douglas S
authors: DS
authors: Tyler
authors: Department of Surgery, Duke University, Durham, North California.
authors: Rebekah R
authors: RR
authors: White
mesh_terms: D000368:Aged; D019091:Critical Pathways; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D007582:Jejunostomy; D007902:Length of Stay; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D015999:Multivariate Analysis; D010043:Outcome and Process Assessment, Health Care; D016577:Pancreaticoduodenectomy; D011300:Preoperative Care; D012189:Retrospective Studies
keywords: Care plan; Clinical pathway; Critical pathway; Fast-track recovery pathway; Outcomes; Pancreaticoduodenectomy; Standardized care plan; Whipple