Application of Clinical Pathways in Laparoscopic Cholecystectomy: A Contemporary, Case-matched, Clinical Controlled Study_Chinese Journal of Evidence-Based Medicine

Authors：

 LIDong-chuan ¹ , SHENHong ¹ ,  WANGYing-qiang ¹ , MUQi-ming ² , HUANGLing-shan ¹ , HURong ¹

1. Department of Medical Administration, 363 Hospital, Chengdu 610041, China;
2. Department of Hepatopancreatobiliary Surgery, 363 Hospital, Chengdu 610041, China;

Corresponding author：

WANGYing-qiang, Email: wyqchengdu@163.com

Keywords：

Clinical Pathway; Laparoscopic cholecystectomy; Acute calculous cholecystitis; Clinical controlled study

DOI：

10.7507/1672-2531.20140027

Video：

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Objective To explore the effectiveness of clinical pathway (CP) in patients underwent laparoscopic cholecystectomy (LC). Methods A retrospective, case-matched, and clinical controlled study was applied. We selected patients with acute calculous cholecystitis (ACC) who were hospitalized in 363 Hospital and underwent LC between September 2012 and August 2013, and divided them into two groups (non-CP vs. CP:2 to 1) according to sex, age (±5), nation and complications. The indicators including length of stay (LOS), antibiotic usage and per-average hospital expenses were compared between groups. Data were analyzed using SPSS 13.0 software. Results A total of 1 044 patients were included, of which 348 were assigned to CP management (CP group), while the other 696 patients were 2 to 1 matched with those in the CP group. Compared to the non-CP group, the pre-operation LOS and total LOS in the CP group were shortened by 1.23 days and 2.08 days, respectively (P < 0.05); the per-average hospital expenses and per-average expenses of drugs in the CP group were decreased by ￥604.7 yuan and ￥287.5 yuan, respectively (P < 0.05); and the rate of antibiotic and non-restricted antibiotic usage in the CP group were dropped by 4.4% and 7.0%, respectively (P < 0.05). There was no significant difference between the groups in efficiency, hospital-related infection rate, the incidence of adverse events, the restricted and special antibiotic usage rate (P > 0.05). The variation coefficient of patients included in the CP group was 15.8%, and the time which did not meet the admission requirement of CP was the main reason for this variation (27, 49.1%). Conclusion Clinical pathway could shorten the LOS and cut down the total hospital expenses. However, multidisciplinary cooperation is still needed, and we should optimize the CP processes continuously and enhance the flexibility of CP, so as to improve the quality of medical service.

Citation： LIDong-chuan, SHENHong, WANGYing-qiang, MUQi-ming, HUANGLing-shan, HURong. Application of Clinical Pathways in Laparoscopic Cholecystectomy: A Contemporary, Case-matched, Clinical Controlled Study. Chinese Journal of Evidence-Based Medicine, 2014, 14(2): 156-161. doi: 10.7507/1672-2531.20140027 Copy

1.	Coffey RJ, Richards JS, Remmert CS, et al. An introduction to critical paths. Qual Manag Health Care, 1992, 1(1):45-54.
2.	Pearson SD, Goulart-Fisher D, Lee TH. Critical pathways as a strategy for improving care:problems and potential. Ann Intern Med, 1995, 123(12):941-948.
3.	Choi JW, Xuan Y, Hur H, et al. Outcomes of Critical Pathway in Laparoscopic and Open Surgical Treatments for Gastric Cancer Patients:Patients Selection for Fast-Track Program through Retrospective Analysis. J Gastric Cancer, 2013, 13(2):98-105.
4.	Jabbour M, Curran J, Scott SD, et al. Best strategies to implement clinical pathways in an emergency department setting:study protocol for a cluster randomized controlled trial. Implement Sci, 2013, 8:55.
5.	Lau TW, Fang C, Leung F. The effectiveness of a geriatric hip fracture clinical pathway in reducing hospital and rehabilitation length of stay and improving short-term mortality rates. Geriatr Orthop Surg Rehabil, 2013, 4(1):3-9.
6.	Yokoe M, Takada T, Strasberg SM, et al. TG13 diagnostic criteria and severity grading of acute cholecystitis(with videos). J Hepatobiliary Pancreat Sci, 2013, 20(1):35-46.
7.	Yamashita Y, Takada T, Strasberg SM, et al. TG13 surgical management of acute cholecystitis. J Hepatobiliary Pancreat Sci, 2013, 20(1):89-96.
8.	中华医学会.临床诊疗指南外科学分册.北京:人民卫生出版社, 2006:293-294.
9.	王应强, 李鸿浩, 李幼平, 等.我国示范乡镇卫生院基本药物循证评价与遴选之十:急性胆囊炎.中国循证医学杂志, 2012, 12(08):939-947.
10.	Yamashita Y, Takada T, Kawarada Y, et al. Surgical treatment of patients with acute cholecystitis:Tokyo Guidelines. J Hepatobiliary Pancreat Surg, 2007, 14(1):91-97.
11.	杜凯, 于保荣, 杨帆, 等.临床路径和支付方式改革在胆结石腹腔镜手术患者中的应用效果评估.中国卫生经济, 2012, 31(12):78-80.
12.	王长林, 许志宏.临床路径在腹腔镜胆囊切除术患者中的应用效果分析.中国医药导刊, 2013, (1):41-42+44.
13.	刘思, 马秀清.新型临床路径在腹腔镜胆囊切除术住院患者中的应用和评价.华西医学, 2012, 27(12):1864-1865.
14.	吴在德, 吴肇汉.外科学.第7版.北京:人民卫生出版社, 2008:578-588.
15.	胡善联.卫生经济学.第1版.上海:复旦大学出版社, 2003:221-332.
16.	Ban A, Ismail A, Harun R, et al. Impact of clinical pathway on clinical outcomes in the management of COPD exacerbation. BMC Pulm Med, 2012, 12:27.
17.	徐锡武, 陈彤, 窦婧婧, 等.单病种临床路径实施效果评价.中国病案, 2012, 13(5):54-55.
18.	刘思, 马秀清.临床路径在腹腔镜胆囊切除术中的应用和评价.华西医学, 2012, 27(12):1864-1865.
19.	齐德广, 秦银河, 李书章, 等.胆囊结石腹腔镜胆囊切除术临床路径实施效果分析.第三军医大学学报, 2003, 25(12):1092-1094.
20.	薛军, 黄先涛, 王佃国.临床路径用于胆囊结石腹腔镜胆囊切除术单病种质量控制的研究.腹腔镜外科杂志, 2009, 14(12):955-957.
21.	寇利琼, 方素.临床路径在腹腔镜胆囊切除术中的应用.西部医学, 2012, 24(06):1141-1142.
22.	彭英, 朱肖, 熊秀娥.临床路径在腹腔镜胆囊切除术中的应用及分析.临床医学, 2011, 31(1):4-5.
23.	赵秀兰, 杨辉, 杨晓丽.胆囊切除术病人实施临床路径的影响因素分析.护理研究, 2012, 26(13):1195-1198.
24.	韦红英, 谈燕飞.临床路径在腹腔镜胆囊切除术患者中的变异分析.现代临床护理, 2008, 7(6):14-16.

1. Coffey RJ, Richards JS, Remmert CS, et al. An introduction to critical paths. Qual Manag Health Care, 1992, 1(1):45-54.
2. Pearson SD, Goulart-Fisher D, Lee TH. Critical pathways as a strategy for improving care:problems and potential. Ann Intern Med, 1995, 123(12):941-948.
3. Choi JW, Xuan Y, Hur H, et al. Outcomes of Critical Pathway in Laparoscopic and Open Surgical Treatments for Gastric Cancer Patients:Patients Selection for Fast-Track Program through Retrospective Analysis. J Gastric Cancer, 2013, 13(2):98-105.
4. Jabbour M, Curran J, Scott SD, et al. Best strategies to implement clinical pathways in an emergency department setting:study protocol for a cluster randomized controlled trial. Implement Sci, 2013, 8:55.
5. Lau TW, Fang C, Leung F. The effectiveness of a geriatric hip fracture clinical pathway in reducing hospital and rehabilitation length of stay and improving short-term mortality rates. Geriatr Orthop Surg Rehabil, 2013, 4(1):3-9.
6. Yokoe M, Takada T, Strasberg SM, et al. TG13 diagnostic criteria and severity grading of acute cholecystitis(with videos). J Hepatobiliary Pancreat Sci, 2013, 20(1):35-46.
7. Yamashita Y, Takada T, Strasberg SM, et al. TG13 surgical management of acute cholecystitis. J Hepatobiliary Pancreat Sci, 2013, 20(1):89-96.
8. 中华医学会.临床诊疗指南外科学分册.北京:人民卫生出版社, 2006:293-294.
9. 王应强, 李鸿浩, 李幼平, 等.我国示范乡镇卫生院基本药物循证评价与遴选之十:急性胆囊炎.中国循证医学杂志, 2012, 12(08):939-947.
10. Yamashita Y, Takada T, Kawarada Y, et al. Surgical treatment of patients with acute cholecystitis:Tokyo Guidelines. J Hepatobiliary Pancreat Surg, 2007, 14(1):91-97.
11. 杜凯, 于保荣, 杨帆, 等.临床路径和支付方式改革在胆结石腹腔镜手术患者中的应用效果评估.中国卫生经济, 2012, 31(12):78-80.
12. 王长林, 许志宏.临床路径在腹腔镜胆囊切除术患者中的应用效果分析.中国医药导刊, 2013, (1):41-42+44.
13. 刘思, 马秀清.新型临床路径在腹腔镜胆囊切除术住院患者中的应用和评价.华西医学, 2012, 27(12):1864-1865.
14. 吴在德, 吴肇汉.外科学.第7版.北京:人民卫生出版社, 2008:578-588.
15. 胡善联.卫生经济学.第1版.上海:复旦大学出版社, 2003:221-332.
16. Ban A, Ismail A, Harun R, et al. Impact of clinical pathway on clinical outcomes in the management of COPD exacerbation. BMC Pulm Med, 2012, 12:27.
17. 徐锡武, 陈彤, 窦婧婧, 等.单病种临床路径实施效果评价.中国病案, 2012, 13(5):54-55.
18. 刘思, 马秀清.临床路径在腹腔镜胆囊切除术中的应用和评价.华西医学, 2012, 27(12):1864-1865.
19. 齐德广, 秦银河, 李书章, 等.胆囊结石腹腔镜胆囊切除术临床路径实施效果分析.第三军医大学学报, 2003, 25(12):1092-1094.
20. 薛军, 黄先涛, 王佃国.临床路径用于胆囊结石腹腔镜胆囊切除术单病种质量控制的研究.腹腔镜外科杂志, 2009, 14(12):955-957.
21. 寇利琼, 方素.临床路径在腹腔镜胆囊切除术中的应用.西部医学, 2012, 24(06):1141-1142.
22. 彭英, 朱肖, 熊秀娥.临床路径在腹腔镜胆囊切除术中的应用及分析.临床医学, 2011, 31(1):4-5.
23. 赵秀兰, 杨辉, 杨晓丽.胆囊切除术病人实施临床路径的影响因素分析.护理研究, 2012, 26(13):1195-1198.
24. 韦红英, 谈燕飞.临床路径在腹腔镜胆囊切除术患者中的变异分析.现代临床护理, 2008, 7(6):14-16.

Chinese Journal of Evidence-Based Medicine

Application of Clinical Pathways in Laparoscopic Cholecystectomy: A Contemporary, Case-matched, Clinical Controlled Study

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