title: The application of clinical pathways in laparoscopic cholecystectomy.
abstract: BACKGROUND
  Laparoscopic cholecystectomy (LC) is one of the most frequent abdominal surgical procedures. The present meta-analysis aimed to estimate the clinical effects of implementing a clinical pathway for LC compared with standard medical care by evaluating the length of hospital stay, costs, and the outcomes of patients undergoing LC.
  
  
  METHODS
  Data were extracted from the following databases: PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, Chinese Medical Citation Index (CMCI), Chinese Medical Current Contents (CMCC), and China BioMedical Literature Database (CBM). We also searched the reference lists of the relevant articles and conference articles. Only randomized controlled trials and controlled clinical trials published from 1980 to 2013 were included. We did not set restrictions on language and country of publications. All of the data were evaluated and analyzed by two reviewers independently with RevMan software (version 5.0).
  
  
  RESULTS
  A total of 7 trials with 1187 patients were included. The patients who underwent LC with clinical pathway had shorter hospital stay [weighted mean difference=-1.90, 95% CI: -2.65 to -1.16, P<0.00001], lower cost [standard mean difference=-0.69, 95% CI: -0.82 to -0.56, P<0.00001], and better questionnaires based satisfaction with the medical services.
  
  
  CONCLUSIONS
  The applications of the clinical pathway for LC effectively reduced hospital stay and total costs. However, there was insufficient evidence for proving the differences in postoperative complications. Future research should focus on patient outcomes and identify the mechanisms underlying the effect of the clinical pathway.
authors.affiliation: Department of General Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China. shusenzheng@zju.edu.cn.
authors.forename: Min
authors.initials: M
authors.lastname: Zhang
authors.forename: Shu-Yang
authors.initials: SY
authors.lastname: Zhou
authors.forename: Mei-Yuan
authors.initials: MY
authors.lastname: Xing
authors.forename: Jian
authors.initials: J
authors.lastname: Xu
authors.forename: Xiao-Xiao
authors.initials: XX
authors.lastname: Shi
authors.forename: Shu-Sen
authors.initials: SS
authors.lastname: Zheng
mesh_terms: D016009:Chi-Square Distribution; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000191:economics; D017046:Cost Savings; D019091:Critical Pathways / Q000191:economics; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D011183:Postoperative Complications / Q000191:economics / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome