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Tatyan Clarke, MD; Helen Sohn, MD; Rebecca Kelso, MD; Mikael Petrosyan, MD; Shirin Towfigh, MD; Rodney Mason, MD, PhD

Arch Surg. 2008;143(9):901-906.

Hypothesis  We assessed outcomes in patients with gallstone pancreatitis (GSP) managed using a readmission pathway of discharge from the index admission with early readmission cholecystectomy and compared these with conventional management. We hypothesized that the pathway would decrease hospital length of stay (LOS).

Design  Prospective cohort study.

Setting  County-based academic center.

Patients  All patients admitted with GSP between June 1, 2005, and June 30, 2007. The control group consisted of patients from the year before the adoption of the readmission pathway. The pathway group patients were enrolled in the first year from its inception (July 1, 2006).

Main Outcome Measures  Overall LOS, time from admission until operation, and pathway failures.

Results  Of 252 patients with GSP, 144 were managed by conventional methods, and 108 were managed using the readmission pathway. The overall mean (SD) LOS was 8.5 (6.0) days in the control group and 5.9 (3.1) days in the pathway group (P < .001). The mean (SD) times to surgery were 6.6 (4.5) days in the control group and 22.7 (10.4) days in the pathway group (P =.01). This did not lead to significantly more treatment failures, with 34 (23.6%) in the control group and 33 (30.6%) in the pathway group (P =.21). There were 6.5%(7 of 108) unplanned readmissions for recurrent pancreatitis in the pathway group. Morbidity was otherwise similar in both groups.

Conclusion  Use of the readmission pathway's early discharge protocol decreased overall LOS and in this study population was not associated with any increase in morbidity compared with conventional management.

Author Affiliations: Division of Emergency Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California and Los Angeles County—USC Medical Center (Drs Clarke, Sohn, Petrosyan, and Mason), and Department of Surgery, Cedars-Sinai Medical Center (Dr Towfigh), Los Angeles; and Department of Vascular Surgery, Cleveland Clinic, Cleveland, Ohio (Dr Kelso).

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