New approach to care after surgery reduces hospital stays, costs
A bold new approach that gets people out of the hospital more quickly after a major cancer surgery is producing excellent outcomes and reducing costs for patients at the University of Virginia Health System, a new study shows.
U.Va. researchers set out to evaluate the safety and effectiveness of a streamlined approach to postoperative care following what is known as a "Whipple procedure." The complex surgery – also known as a pancreaticoduodenectomy – treats tumors of the pancreas and its surroundings.
A typical hospital stay for a Whipple procedure is 10 days to two weeks. The streamlined approach tested at U.Va. aims to reduce that to only six days. The clinical trial of the new approach found that the median stay was seven days, with 41 percent of patients out of the hospital by the sixth day.
"This represents the shortest postoperative clinical pathway that has been described in the medical literature," said U.Va.'s Dr. Todd W. Bauer, who launched the approach and led the trial.
Recovery time after a procedure is particularly important for patients with cancer, as it allows them to begin chemotherapy six weeks after surgery, Bauer noted. "Not only is it important for the patients' quality of life, this will impact their long-term survival," he said.
The study examined outcomes for 113 patients who underwent a Whipple procedure using the new clinical pathway. There have been zero deaths in the seven years since the study began, compared with a reported mortality rate of 1 percent to 2 percent at many hospitals that perform the procedure.
Bauer attributes the success of U.Va.'s approach to several key factors:
- Minimizing blood loss during the procedure and avoiding blood transfusions
- Taking a meticulous approach to the surgery, to prevent complications
- Establishing a clear timeline charting milestones after surgery
- Ensuring all care providers are working in unison
- Educating patients on what to expect each day and actively involving them in their care.
The study's findings have been published online by the journal HPB. The article's authors are Dustin M. Walters, Patrick McGarey, Damien J. LaPar, Aimee Strong, Elizabeth Good, Reid B. Adams and Bauer.
In the wake of the success of the trial, U.Va. is implementing the new approach permanently, Bauer said.
"We do a lot of these, and that contributes to our positive outcomes," he said of the Whipple procedure. "But our goal is not just to do a lot of these – it's to have the best possible outcome for every patient. … So it has been very rewarding for us to see our patients doing so well."