Variation Analysis Of Clinical Pathways In Laparoscopic Cholecystectomy

[Objectives]Our study aims to analyze clinical pathway variation by retrospective study about consequences of the patients undergone laparoscopic cholecystectomy(LC)pathway and improve the clinical pathway of laparoscopic cholecystectomy.[Methods]We retrospectively analyzed clinical data of the patients undergone laparoscopic cholecystectomy pathway in GanMei hospital affiliated to Kunming Medical University froom January 2015 to December 2016.Inclusive criteria:cases undergone laparoscopic cholecystectomy pathway;exclusion criteria:cases which have not.All the cases were divided into complete set of clinical pathway(group A)and out set(group B).Group B was then divided into surgical treatment group(group B1)and non-surgical treatment group(group B2).Analysing age,gender,blood routine index,hepatic and renal fuction,high-sensitivity C-reactive protein,pre-andpostoperative abdominal ultrasound examination,total length of hospital stay and total hospitalization cost.And then analysing the causes of dropping-out in group B,summarizing and improving the completion of clinical pathway.Statistical analysis was carried out using the SPSS(Version 20.0).The differrences between groups in quantitative data were performed in nonparametric Mann-Whitney test.Comparisons of frequencies in qualitative data were made with Pearson s chi-square test or Fisher-s exact test.P values below 0.05 were considered statistically significant.[Result:]1.There were 231cases included,182 cases belong to group A,accountting for 78.79%,age ranging from 18 to 82,the median age was 46.5410.90,among 64 were male and 118 female.There were 49 cases in group B,age ranging from 24 to 85,the median age was 50.73±1.99,among 28 were male and 21 female.2.The length of hospital stay in group A was obviously shorten than group B(5.79±0,15 VS.11.53±0.73,P<0.0001),and the hospitalization cost of group A was less than group B(7931±159.9 VS.12120±705.7,P<0.0001),both difference were statistically significant.3.The operation rate in group A was 100%,the cure rate 100%.Whereas the operation rate in group B was 53.06%,the cure rate 100%.Both no complications after the operation,such as bile leakage,bleeding and infection.The preoperation glutamic-pyruvic transaminase(ALT),glutamic-oxalacetic transaminase(AST)and postoperation high-sensitivity C-reactive protein of group B were higher than group A,all beyond the normal(96.24IU/L vs.44.97IU/L,P=0.0054;44.24IU/L vs.29.52IU/L;P=0.023;57.54mg/L vs.34.06mg/L,P=0.010).Other clinical indicators such as TBIL and ALB,there is no obvious difference between group A and B.4.The median age of group B were older than group A(50.73±1.99 VS.46.54 ?±0.90,P>0.05).The proportion of elderly patients in group B was higher than group A(4.40%(8/182)VS.12.24%(6/49)),but had no statistical significance(P=0.051).The proportion of male patients in group B was higher than group A(35.2%(64/182)VS.57.1%(28/49)),and had statistical significance(P=0.005).There were 26 cases undergone operative treatment,named group Bl,and the others not named B2.The operative rate was 53.06%.We then divided group B1 into 4 subgroup,group B1a:5 cases,who undergone laparoscopic cholecystectomy,dropped out when arose symptoms which had nothing to do with the operation;group Blb:6 cases,who gonethrough open cholecystectomy and/or biliary surgical exploration straightly;group B1c:8 cases,who transfered to laparotomy after laparoscopic cholecystectomy;B1d:7 cases,who delayed laparoscopic cholecystectomy because of related inspection or female menstruation before operation.While group B2 was divided into 4 subgroup also,group B2a:3 cases,who had no surgery due to the operation risk;B2b:3 cases,who had no surgical indications;B2c:8 cases,who refused to have a operation;B2d:9 cases,who then performed inspection when other diseases occured before peration.Controlled variable cases have 21 cases,including some B1b,B1d,B2a and B2c group,accounting for 42.85%,the controlled variable cases have 28 cases,is the main reason for the LC clinical path variation.[Conclusion]1.The application of clinical pathway in laparoscopic cholecystectomy could shorten the length of hospital stay and lessen the hospitilazation cost,improve patients satisfaction.2.The possibility of male patients clinical path variation is higher.3.The controllable factors is the main cause of clinical path variation of laparoscopic cholecystectomy.4.By optimizing the preoperative evaluation and management,we can further reduce the controllable factors of clinical path variation of laparoscopic cholecystectomy.