Indication of a Clinical Pathway for Hepatectomy on Variance Analysis

Naoto Gotohda, Masaru Konishi, Toshio Nakagohri, Shinichiro Takahashi and Taira Kinoshita

Department of Surgery, National Cancer Center Hospital East

Purpose: We studied the incidence of variance and outcome of a clinical pathway (CP) for hepatectomy. Patients and Methods: From January 2003, a CP was introduced in management of hepatectomy without reconstruction of the bile duct. From January to December 2004, a CP was implemented for 115 patients undergoing hepatectomy without reconstruction of the bile duct. Results: Patients completing the CP were 80%. Mean postoperative hospitalization stay was 9.0 days. Clinical factors correlated with the incidence of variance were the type of disease (primary liver cancer or metastatic liver tumor), surgical procedure, operating time, blood loss, blood transfusion, and the amount of diet on postoperative day (POD) 2. Conclusions: We evaluated indications of a CP for hepatectomy. The most useful clinical factor was operating time. The frequency of incidence of variance will be probably high if we cannot conduct hepatectomy within a 5-hour operation.

Key words
clinical pathway, hepatectomy, hepatocellular carcinoma, variance, outcome

Reprint requests
Naoto Gotohda Department of Surgery, National Cancer Center Hospital East
6-5-1 Kashiwanoha, Kashiwa, 277-8577 JAPAN

Accepted
June 22, 2005

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