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.	中華醫學會.臨床診療指南外科學分冊.北京:人民衛生出版社, 2006:293-294.
9.	王應強, 李鴻浩, 李幼平, 等.我國示范鄉鎮衛生院基本藥物循證評價與遴選之十:急性膽囊炎.中國循證醫學雜志, 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.	杜凱, 于保榮, 楊帆, 等.臨床路徑和支付方式改革在膽結石腹腔鏡手術患者中的應用效果評估.中國衛生經濟, 2012, 31(12):78-80.
12.	王長林, 許志宏.臨床路徑在腹腔鏡膽囊切除術患者中的應用效果分析.中國醫藥導刊, 2013, (1):41-42+44.
13.	劉思, 馬秀清.新型臨床路徑在腹腔鏡膽囊切除術住院患者中的應用和評價.華西醫學, 2012, 27(12):1864-1865.
14.	吳在德, 吳肇漢.外科學.第7版.北京:人民衛生出版社, 2008:578-588.
15.	胡善聯.衛生經濟學.第1版.上海:復旦大學出版社, 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.	徐錫武, 陳彤, 竇婧婧, 等.單病種臨床路徑實施效果評價.中國病案, 2012, 13(5):54-55.
18.	劉思, 馬秀清.臨床路徑在腹腔鏡膽囊切除術中的應用和評價.華西醫學, 2012, 27(12):1864-1865.
19.	齊德廣, 秦銀河, 李書章, 等.膽囊結石腹腔鏡膽囊切除術臨床路徑實施效果分析.第三軍醫大學學報, 2003, 25(12):1092-1094.
20.	薛軍, 黃先濤, 王佃國.臨床路徑用于膽囊結石腹腔鏡膽囊切除術單病種質量控制的研究.腹腔鏡外科雜志, 2009, 14(12):955-957.
21.	寇利瓊, 方素.臨床路徑在腹腔鏡膽囊切除術中的應用.西部醫學, 2012, 24(06):1141-1142.
22.	彭英, 朱肖, 熊秀娥.臨床路徑在腹腔鏡膽囊切除術中的應用及分析.臨床醫學, 2011, 31(1):4-5.
23.	趙秀蘭, 楊輝, 楊曉麗.膽囊切除術病人實施臨床路徑的影響因素分析.護理研究, 2012, 26(13):1195-1198.
24.	韋紅英, 談燕飛.臨床路徑在腹腔鏡膽囊切除術患者中的變異分析.現代臨床護理, 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. 中華醫學會.臨床診療指南外科學分冊.北京:人民衛生出版社, 2006:293-294.
9. 王應強, 李鴻浩, 李幼平, 等.我國示范鄉鎮衛生院基本藥物循證評價與遴選之十:急性膽囊炎.中國循證醫學雜志, 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. 杜凱, 于保榮, 楊帆, 等.臨床路徑和支付方式改革在膽結石腹腔鏡手術患者中的應用效果評估.中國衛生經濟, 2012, 31(12):78-80.
12. 王長林, 許志宏.臨床路徑在腹腔鏡膽囊切除術患者中的應用效果分析.中國醫藥導刊, 2013, (1):41-42+44.
13. 劉思, 馬秀清.新型臨床路徑在腹腔鏡膽囊切除術住院患者中的應用和評價.華西醫學, 2012, 27(12):1864-1865.
14. 吳在德, 吳肇漢.外科學.第7版.北京:人民衛生出版社, 2008:578-588.
15. 胡善聯.衛生經濟學.第1版.上海:復旦大學出版社, 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. 徐錫武, 陳彤, 竇婧婧, 等.單病種臨床路徑實施效果評價.中國病案, 2012, 13(5):54-55.
18. 劉思, 馬秀清.臨床路徑在腹腔鏡膽囊切除術中的應用和評價.華西醫學, 2012, 27(12):1864-1865.
19. 齊德廣, 秦銀河, 李書章, 等.膽囊結石腹腔鏡膽囊切除術臨床路徑實施效果分析.第三軍醫大學學報, 2003, 25(12):1092-1094.
20. 薛軍, 黃先濤, 王佃國.臨床路徑用于膽囊結石腹腔鏡膽囊切除術單病種質量控制的研究.腹腔鏡外科雜志, 2009, 14(12):955-957.
21. 寇利瓊, 方素.臨床路徑在腹腔鏡膽囊切除術中的應用.西部醫學, 2012, 24(06):1141-1142.
22. 彭英, 朱肖, 熊秀娥.臨床路徑在腹腔鏡膽囊切除術中的應用及分析.臨床醫學, 2011, 31(1):4-5.
23. 趙秀蘭, 楊輝, 楊曉麗.膽囊切除術病人實施臨床路徑的影響因素分析.護理研究, 2012, 26(13):1195-1198.
24. 韋紅英, 談燕飛.臨床路徑在腹腔鏡膽囊切除術患者中的變異分析.現代臨床護理, 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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