Research Article

Department of Gastrointestinal Surgery, Gastrointestinal Oncology, & Bariatric Surgery, Medanta Institute of Digestive & Hepatobiliary Sciences, Medanta, The Medicity, Gurgaon, India

Department of Liver Transplantation & Regenerative Medicine, Medanta-The Medicity, Gurgaon, Haryana, India

Savio George Barreto

https://orcid.org/0000-0002-4999-5657

Department of Gastrointestinal Surgery, Gastrointestinal Oncology, & Bariatric Surgery, Medanta Institute of Digestive & Hepatobiliary Sciences, Medanta, The Medicity, Gurgaon, India

College of Medicine & Public Health, Flinders University, South Australia, Australia

Division of Surgery & Perioperative Medicine, Flinders Medical Center, Bedford Park, Adelaide, South Australia, Australia

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Manish Kumar Singh

Department of Clinical Research, Medanta, The Medicity, Gurgaon, India

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Deeksha Kapoor

Department of Gastrointestinal Surgery, Gastrointestinal Oncology, & Bariatric Surgery, Medanta Institute of Digestive & Hepatobiliary Sciences, Medanta, The Medicity, Gurgaon, India

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Adarsh Chaudhary

*Author for correspondence: Fax: +91 2414 8114;

E-mail Address: adarsh_chaudhary@yahoo.com

Department of Gastrointestinal Surgery, Gastrointestinal Oncology, & Bariatric Surgery, Medanta Institute of Digestive & Hepatobiliary Sciences, Medanta, The Medicity, Gurgaon, India

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Published Online:8 Jun 2020https://doi.org/10.2217/fon-2020-0120

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Abstract

Aim: To determine the frequency and relevance of deviations from a post pancreatoduodenectomy (PD) clinical care pathway. Materials & methods: A retrospective analysis using a prospectively maintained database of a post-PD clinical care pathway was carried out between May 2016 and March 2018. Patients were divided based on the number of factors deviating from the clinical care pathway (Group I: no deviation; Group II: deviation in 1–4 factors; Group III: deviation in 5–8 factors). The analysis included profiling of patients on different demographic and clinical as well as medical and surgical outcome parameters (discharge by postoperative day 8 and 90-day unplanned re-admission rate). Results: Post-PD clinical care pathways are feasible but deviations from the pathway are frequent (91%). An increase in frequency of deviations from the pathway was significantly associated with increased risk of POPF and delayed gastric emptying, delayed discharge, risk of mortality and 90-day unplanned re-admission rate. Conclusion: Deviations from a post-PD clinical care pathway are common. Poor nutrition and cardiac co-morbidities are associated with an increased likelihood of deviation. As the number of deviations increase, so does the risk of significant complications and interventions, delayed discharge and 90-day re-admission rate.

Keywords:

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Vol. 16, No. 24

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History

Received 15 February 2020

Accepted 20 May 2020

Published online 8 June 2020

Published in print August 2020

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Keywords

Author contributions

M Karunakaran: Data collection and analysis, drafting of manuscript. SG Barreto: Conceptualization and study design; data analysis and drafting the manuscript. MK Singh: Data analysis and critical review of the manuscript. D Kapoor: Data collection and critical review of the manuscript. A Chaudhary: Conceptualization of the study; critical review of the manuscript. All five authors: Final approval of the version to be published; AND Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The study has been approved by the Institutional Review Board and the Ethics Committee of the Medanta, The Medicity (Approval No: MICR-604/2016). An informed consent was obtained from all patients prior to their surgery.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Deviations from a clinical pathway post pancreatoduodenectomy predict 90-day unplanned re-admission

Abstract

References