The Effectiveness of a Clinical Pathway in Liver Surgery: a Case-Control Study
In the field of liver surgery, evidence on the effectiveness of clinical pathways based on ERAS principles is limited.
This is a single-center observational study from a prospectively maintained database. Two cohorts were formed of all patients undergoing liver surgery during a defined period before (traditional management) and after introduction of a clinical pathway. Additionally, a case-match analysis—based on approach, tumor location, and Brisbane classification of resection—was performed. A cost analysis and patient satisfaction questionnaire were carried out.
In both the overall analysis (n = 229) as well as the case-match analysis (n = 100), hospital stay was significantly reduced from 8 to 4 days and from 6.5 to 4 days, respectively (p < 0.05). Postoperative morbidity (traditional management 11/50 vs clinical pathway 5/50; p = 1.00) and readmission rate did not increase. Cost analysis showed a significant decrease in postoperative costs in favor of the clinical pathway (traditional management €3666.7 vs clinical pathway €1912.2; p < 0.001). Overall, 92.3% of the survey questions were answered with satisfied (86.0%) or very satisfied (6.3%).
Implementation of clinical pathway for liver surgery is feasible and safe. A clinical pathway significantly reduces hospital stay without increasing postoperative morbidity and readmission rates. Postoperative costs are significantly reduced. Patient satisfaction is high.
KeywordsLiver surgery ERAS Clinical pathway
Sander Ovaere: data analysis and writing, first author.
Isabelle Boscart: data collection and analysis.
Isabelle Parmentier: data collection and analysis.
Pieter Jan Steelant: study design and writing.
Tino Gabriel: study design and financial analysis.
Junior Allewaert: study design.
Hans Pottel: data collection and analysis.
Franky Vansteenkiste: study design and writing.
Mathieu D’Hondt: study design, data analysis and writing, senior author.
All authors meet all 4 criteria per the guidelines of the International Committee of Medical Journal Editors (ICMJE).
Compliance with Ethical Standards
The study was approved by the local ethics committee (AZGS2016072).
Conflict of Interest
The authors declare that they have no conflict of interest.
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