title: Impact of critical pathway implementation on hospital stay and costs in patients undergoing pancreaticoduodenectomy.
abstract: OBJECTIVE
  Recent studies have shown that pancreaticoduodenectomy (PD) can be performed quite safely. Critical pathway (CP) has been one of the key tools used to achieve excellent outcomes in high-quality, high-volume centers. This study was designed to evaluate the impact of CP implementation for PD patients.
  
  
  METHODS
  The important components of CP for PD patients include the early start of an oral diet and removal of the abdomen drain following follow-up computed tomography, with the intention of shortening the postoperative hospital stay. The study group (CP group) comprised of 88 patients who underwent pylorus-preserving or classical PD from January 2009 to December 2010. The control group (pre-CP group) was 185 patients who underwent PD between January 2005 and December 2008.
  
  
  RESULTS
  The two groups did not show significant differences in demographic profiles and the primary diagnosis. The incidences of overall postoperative complications such as delayed gastric emptying, fistula, and hemorrhage were similar or decreased in the CP group (54% vs. 40.9%). The incidence of clinically significant complications also showed a similar rate (5.4% vs. 4.5%) between the two groups. The nutritional status at discharge and re-admission rates were not different. The CP group showed a significantly shorter postoperative hospital stay (20.2±9.2 days vs. 14.9±5.1 days, p<0.001) and the total medical costs were also significantly reduced, by 15% (p<0.001).
  
  
  CONCLUSIONS
  The results of this study indicated that the implementation of CP for PD patients can decrease the length of hospital stay and reduce medial costs, with maintenance or improvement of patient outcomes. Further investigation is necessary to validate the actual impact of CP for PD through multi-center high-volume studies.
authors.affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Hyoung-Eun
authors.initials: HE
authors.lastname: Kim
authors.affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Young Hoon
authors.initials: YH
authors.lastname: Kim
authors.affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Ki Byung
authors.initials: KB
authors.lastname: Song
authors.affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Young Soo
authors.initials: YS
authors.lastname: Chung
authors.affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Shin
authors.initials: S
authors.lastname: Hwang
authors.affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Young Ju
authors.initials: YJ
authors.lastname: Lee
authors.affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Kwang Min
authors.initials: KM
authors.lastname: Park
authors.affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Song-Cheol
authors.initials: SC
authors.lastname: Kim
keywords: Complication; Critical pathway; Hospital stay; Medical cost; Pancreaticoduodenectomy