Impact of a Clinical Pathway for Pancreaticoduodenectomy on Cost Quality Outcomes and Patient Satisfaction

Kenichi Hakamada, Shunji Narumi, Yoshikazu Toyoki, Eishi Totsuka, Syuichi Yoshihara, Takayuki Morita and Mutsuo Sasaki

Department of Surgery II, Hirosaki University School of Medicine

Aim: We evaluated a clinical pathway (CP) introduced in the management of pancreaticoduodenectomy, which has a high incidence of postoperative complications. Patients and Methods: Forty consecutive patients who underwent pancreaticoduodenectomy at our institute between October 2000 and August 2002 were included. Antibiotics and other perioperative medication were used based on current standards throughout the period. Physicians were asked to use the CP, which was created based on samples with the best clinical course among 14 patients before August 2001 (pre-CP), for the treatment of 26 patients thereafter (post-CP). Results: Among the 46% of patients completing the CP, the incidences of postoperative complications did not differ between pre- and post-CP. Postoperative hospital stay was reduced significantly after CP implementation (median 30 vs. 34 days, p=0.04), especially in on-path cases (24 vs. 30 days, p=0.01). Hospital charges were also significantly reduced (¥814,640 vs. ¥954,960, p=0.02), thanks mainly to a drop in the cost of medication, postoperative surgical procedures, and laboratory tests. In on-path cases, hospital charges were significantly lower than those off-path (¥656,780 vs. ¥842,160, p=0.005), and 73% of on-path patients were satisfied with the time and quality of treatment. Conclusions: The CP is feasible even in cases with a high rate of variances, as in pancreaticoduodenectomy. CP implementation primarily benefits on-path patients and helps to raise cost quality outcomes on the whole while maintaining the safety of surgical intervention and patient satisfaction.

Key words
clinical pathway, pancreaticoduodenectomy, cost quality outcome, hospital stay, variance

Reprint requests
Kenichi Hakamada Department of Surgery II, Hirosaki University School of Medicine
5 Zairucho, Hirosaki, 036-8216 JAPAN

Accepted
November 26, 2003

To read the PDF file you will need Abobe Reader installed on your computer.