Implementation of a Critical Pathway for Patients with Acute Cholecystitis.
10.7602/jmis.2013.16.4.87
- Author:
Sa Hong MIN
1
;
Ho Seong HAN
;
Jai Young CHO
;
Yoo Seok YOON
;
Dae Wook HWANG
;
Kyuwhan JUNG
;
Young Ki KIM
;
Hong Kyung SHIN
;
Woohyung LEE
Author Information
1. Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea. hanhs@snubh.org
- Publication Type:Original Article
- Keywords:
Critical pathway;
Acute cholecystitis;
Laparoscopic cholecystectomy;
Length of stay
- MeSH:
Cholecystectomy;
Cholecystectomy, Laparoscopic;
Cholecystitis;
Cholecystitis, Acute*;
Critical Pathways*;
Demography;
Gallbladder Diseases;
Humans;
Length of Stay;
Postoperative Complications
- From:Journal of Minimally Invasive Surgery
2013;16(4):87-90
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: Since introduction of the laparoscopic procedure for cholecystectomy, it has become the treatment of choice for symptomatic gallbladder diseases. Previous studies have demonstrated that implementation of critical pathway (CP) in laparoscopic cholecystectomy (LC) is effective in reducing cost in terms of length of stay (LOS) and revisit rates. However, few studies have proven the effectiveness of critical pathway specifically in patients with acute cholecystitis (AC). METHODS: CP was introduced for LC for chronic cholecystitis (CC) in April 2008. Then, indication for CP was extended to AC in May 2010. We compared outcomes of LC for patients with AC between two eras, including Pre-CP (Jan 2007 to Mar 2008) and Post-CP (May 2010 to Jun 2011). Among 78 patients with AC, 70 patients (90%) were enrolled for the critical pathway. Among them, 55 patients (79%) were discharged with full application of CP; however, it was suspended in 15 patients (21%). RESULTS: No differences in demographics and clinical characteristics were observed between Pre-CP (n=97) and Post-CP (n=70) patients. The mean LOS before surgery was shorter in the Post-CP group (2.6 vs. 4.0 days, p=.012). In addition, the mean total LOS was shorter in the Post-CP group (5.5 vs. 8.7 days, p<.001). However no differences in postoperative complications were observed between the two groups (10 vs. 5 cases, p=.483). CONCLUSION: Implementation of CP in AC resulted in a decrease in the LOS in total and before surgery, without increasing morbidity. Therefore, critical pathway can be safely implemented for selected patients with AC.
