Deviations from a clinical pathway post pancreatoduodenectomy predict 90-day unplanned re-admission

Monish Karunakaran, Savio George Barreto, Manish Kumar Singh, Deeksha Kapoor, Adarsh Chaudhary

Research output: Contribution to journalArticlepeer-review

9 Citations (Scopus)


Aim: To determine the frequency and relevance of deviations from a post pancreatoduodenectomy (PD) clinical care pathway. Materials & methods: A retrospective analysis using a prospectively maintained database of a post-PD clinical care pathway was carried out between May 2016 and March 2018. Patients were divided based on the number of factors deviating from the clinical care pathway (Group I: no deviation; Group II: deviation in 1-4 factors; Group III: deviation in 5-8 factors). The analysis included profiling of patients on different demographic and clinical as well as medical and surgical outcome parameters (discharge by postoperative day 8 and 90-day unplanned re-admission rate). Results: Post-PD clinical care pathways are feasible but deviations from the pathway are frequent (91%). An increase in frequency of deviations from the pathway was significantly associated with increased risk of POPF and delayed gastric emptying, delayed discharge, risk of mortality and 90-day unplanned re-admission rate. Conclusion: Deviations from a post-PD clinical care pathway are common. Poor nutrition and cardiac co-morbidities are associated with an increased likelihood of deviation. As the number of deviations increase, so does the risk of significant complications and interventions, delayed discharge and 90-day re-admission rate.

Original languageEnglish
Pages (from-to)1839-1849
Number of pages11
JournalFuture Oncology
Issue number24
Publication statusPublished - 1 Aug 2020


  • morbidity
  • mortality
  • outcomes
  • quality
  • surgery


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