Development and implementation of a critical pathway for abdominal aortic aneurysms in Japan

Although the critical pathway (CP) has been implemented successfully for simple procedures and recovery processes, yielding improvement in length of stay (LOS) and patient satisfaction, there are few reports about its application to complicated procedures and recovery processes in Japan. A model was developed of the complicated postoperative abdominal aortic aneurysm (AAA) recovery process from 3-year patient data, including statistics such as days for achieving outcomes, comorbidities, complications, and patient characteristics. Its accuracy has been investigated by comparing patient outcomes. Eighty-three patients were divided into 2 groups (typical and atypical) on the basis of select criteria and analyzed by correlation coefficient, multiple regression analysis, and logistic analysis. No risk factors for delay of the recovery and the adverse outcomes were detected. The CP was the wound healing process in the short-term recovery process. The average LOS was 36.3 days in the typical group and 47.2 days in the atypical group. Stitch removal occurred 8 days after surgery, and patients were discharged a minimum of 11 days after the operation. The AAA-CP has been implemented since September 1998 in 45 experimental cases, and a significant reduction in days required to achieve short-term outcomes has been observed (25.6 days to 19.1 days in LOS after surgery) as well as a decrease in the prevalence of adverse outcomes.