A standardized care plan is associated with shorter hospital length of stay in patients undergoing pancreaticoduodenectomy

Daniel P. Nussbaum, Kara Penne, Sandra S. Stinnett, Paul J. Speicher, Andrei Cocieru, Dan G. Blazer, Sabino Zani, Bryan M. Clary, Douglas S. Tyler, Rebekah R. White

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22 Scopus citations

Abstract

Background: In this retrospective review, we evaluate a standardized care plan (SCP) for patients undergoing pancreaticoduodenectomy, which included selective placement of feeding jejunostomy tubes (FJTs) and a perioperative fast-track recovery pathway (FTRP). Methods: A review of 242 patients undergoing pancreaticoduodenectomy was completed. Patients treated pre- and post-SCP implementation were compared. Univariate comparison followed by multivariable linear regression were performed to identify predictors of hospital length of stay (HLOS). Results: SCP patients (n = 100) were slightly older but otherwise similar to pre-SCP patients (n = 142). FJT placement occurred less frequently in SCP patients (38 versus 94%, P < 0.001). All SCP patients were initiated on the FTRP. Among SCP patients, an oral diet was introduced earlier (5 versus 8.5 d, P < 0.001) and HLOS was shorter (11 versus 13 d, P = 0.015). Readmission rates were similar. Following adjustment with linear regression, we confirmed SCP status as a predictor of HLOS. To assess SCP components, HLOS was evaluated separately based on FTRP status and FJT placement. Although both were highly associated with HLOS, neither was independently predictive in multivariable analysis. Conclusions: Implementation of an SCP resulted in shorter HLOS without an increase in readmissions. Future studies are necessary to identify specific components of SCPs that most influence outcomes.

Original languageEnglish (US)
Pages (from-to)237-245
Number of pages9
JournalJournal of Surgical Research
Volume193
Issue number1
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

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Keywords

  • Care plan
  • Clinical pathway
  • Critical pathway
  • Fast-track recovery pathway
  • Outcomes
  • Pancreaticoduodenectomy
  • Standardized care plan
  • Whipple

ASJC Scopus subject areas

  • Surgery

Cite this

Nussbaum, D. P., Penne, K., Stinnett, S. S., Speicher, P. J., Cocieru, A., Blazer, D. G., Zani, S., Clary, B. M., Tyler, D. S., & White, R. R. (2015). A standardized care plan is associated with shorter hospital length of stay in patients undergoing pancreaticoduodenectomy. Journal of Surgical Research, 193(1), 237-245. https://doi.org/10.1016/j.jss.2014.06.036