Arabacioglu Duygu, Lehn Annette, Herrmann Eva, Albers Benjamin, Hanisch Ernst, Buia Alexander
Department of General, Visceral, and Thoracic Surgery, Asklepios Klinik Langen, Academic Teaching Hospital Goethe University Frankfurt, Langen, Germany.
Department of Biostatistics and Mathematical Modeling, Goethe University Frankfurt, Frankfurt, Germany.
Visc Med. 2021 Feb;37(1):70-76. doi: 10.1159/000506718. Epub 2020 Mar 27.
Care pathways are primarily aimed at decreasing length of hospital stay (LOS) and preventing unnecessary costs while maintaining or improving the quality of care. In laparoscopic cholecystectomy, there is insufficient evidence for proving an impact upon postoperative complications.
In this retrospective study, logistic regression was used to calculate a propensity score, and, after carrying out 1:1 nearest-neighbor matching, 296 patients were analyzed in both groups with regard to postoperative complications using the Clavien-Dindo classification system as a primary aim. In addition, secondary aims were LOS, compliance to care, and deviation from the care pathway with respect to patient discharge. Relative risk of the primary outcome was calculated and compared with the e-value as sensitivity testing approach.
Due to the mandatory part of the care pathway, patient record compliance was 100%. Deviation from the care pathway with respect to the planned patient discharge on postoperative day 2 was noted in 16% of the cases. After adjustment for potential factors, the relative risk when comparing Clavien-Dindo complication grades 0 versus 1-4 is 1.64 (95% CI 0.87-3.11), which did not reach significance ( = 0.127). After matching, LOS lasted 3.69 days without and 3.26 days with the care pathway, respectively.
Against the background of already implemented structured standard operation procedures, a care pathway is not able to reduce postoperative complications. Nevertheless, we consider our clinical pathway a highly valuable tool for the interdisciplinary management of patient hospitalization under the supervision of experienced specialized surgeons.
护理路径主要旨在缩短住院时间（LOS）并防止不必要的费用，同时维持或提高护理质量。在腹腔镜胆囊切除术中，尚无足够证据证明其对术后并发症有影响。
在这项回顾性研究中，采用逻辑回归计算倾向得分，在进行1:1最近邻匹配后，以Clavien-Dindo分类系统为主要目标，对两组中的296例患者的术后并发症进行分析。此外，次要目标包括住院时间、护理依从性以及患者出院时与护理路径的偏差。计算主要结局的相对风险，并与e值进行比较作为敏感性测试方法。
由于护理路径的强制性部分，患者记录的依从性为100%。在16%的病例中，注意到术后第2天计划的患者出院与护理路径存在偏差。在对潜在因素进行调整后，比较Clavien-Dindo并发症0级与1-4级时的相对风险为1.64（95%CI 0.87-3.11），未达到显著性（P = 0.127）。匹配后，无护理路径时住院时间为3.69天，有护理路径时为3.26天。
在已实施结构化标准手术程序的背景下，护理路径无法降低术后并发症。尽管如此，我们认为我们的临床路径是在经验丰富的专科外科医生监督下对患者住院进行跨学科管理的极有价值的工具。
