Iterative Changes in Risk-Stratified Pancreatectomy Clinical Pathways and Accelerated Discharge After...

Area of Science:

• Surgical Pathway Optimization
• Gastrointestinal Surgery Outcomes
• Health Services Research

Background:

• Previous implementation of risk-stratified pancreatectomy clinical pathways (RSPCPs) successfully reduced length of stay (LOS) after pancreaticoduodenectomy (PD).
• This study aimed to evaluate the impact of iterative revisions to RSPCPs on discharge timing and postoperative outcomes.

Purpose of the Study:

• To assess the association between revised RSPCPs and accelerated discharge after pancreaticoduodenectomy.
• To identify predictors of accelerated discharge in patients undergoing pancreaticoduodenectomy under revised pathways.

Main Methods:

• Retrospective cohort study analyzing a prospectively maintained surgical database from October 2016 to September 2020.
• Implementation of revised RSPCPs in February 2019, featuring earlier nasogastric tube (NGT) removal and updated drain fluid amylase criteria.
• Comparison of perioperative outcomes between original and revised pathways, with identification of predictors for accelerated discharge (≤POD 5 for low risk, ≤POD 6 for high risk).

Main Results:

• Revised pathways saw increased POD 1 NGT removal rates; drain removal rates were similar.
• Median LOS decreased significantly for both low-risk (5 vs. 6 days) and high-risk (6 vs. 9 days) patients.
• Early NGT removal correlated with earlier diet tolerance without increased reinsertions; no increase in complications or readmissions was observed.

Conclusions:

• Iterative revisions to RSPCPs further decreased LOS after PD without increasing readmissions.
• Earlier NGT and drain removal are modifiable components within RSPCPs associated with accelerated discharge.
• Optimized clinical pathways are crucial for improving efficiency and patient outcomes in pancreatic surgery.