Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 28, 2019; 25(8): 1002-1011
Published online Feb 28, 2019. doi: 10.3748/wjg.v25.i8.1002
Big-data analysis: A clinical pathway on endoscopic retrograde cholangiopancreatography for common bile duct stones
Wei Zhang, Bing-Yi Wang, Xiao-Yan Du, Wei-Wei Fang, Han Wu, Lei Wang, Yu-Zheng Zhuge, Xiao-Ping Zou
Wei Zhang, Han Wu, Lei Wang, Yu-Zheng Zhuge, Xiao-Ping Zou, Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
Bing-Yi Wang, Xiao-Yan Du, Wei-Wei Fang, Medical Division, Yidu Cloud (Beijing) Technology Co., Ltd. Beijing 100101, China
Author contributions: Zhang W and Zou XP designed the research; Zhang W, Wang BY, Du XY, Fang WW, Wu H, Wang L, and Zhuge YZ performed the research; Du XY, Fang WW, Wu H, and Wang L analyzed the data; Zhang W, Wang BY, and Zhuge YZ wrote the paper; all authors read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of The Affiliated Drum Tower Hospital of Nanjing University Medical School.
Informed consent statement: Patients were not required to give informed written consent prior to the study because the analysis retrospectively used their clinical data.
Conflict-of-interest statement: The authors have no conflict of interests to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Xiao-Ping Zou, PhD, Professor, Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321, Zhongshan Road, Nanjing 210008, Jiangsu Province, China. zouxp@nju.edu.cn
Telephone: +86-13770771661 Fax: +86-25-83106666
Received: December 6, 2018
Peer-review started: December 6, 2018
First decision: January 6, 2019
Revised: January 11, 2019
Accepted: January 18, 2019
Article in press: January 18, 2019
Published online: February 28, 2019
Abstract
BACKGROUND

A clinical pathway (CP) is a standardized approach for disease management. However, big data-based evidence is rarely involved in CP for related common bile duct (CBD) stones, let alone outcome comparisons before and after CP implementation.

AIM

To investigate the value of CP implementation in patients with CBD stones undergoing endoscopic retrograde cholangiopancreatography (ERCP).

METHODS

This retrospective study was conducted at Nanjing Drum Tower Hospital in patients with CBD stones undergoing ERCP from January 2007 to December 2017. The data and outcomes were compared by using univariate and multivariable regression/linear models between the patients who received conventional care (non-pathway group, n = 467) and CP care (pathway group, n = 2196).

RESULTS

At baseline, the main differences observed between the two groups were the percentage of patients with multiple stones (P < 0.001) and incidence of cholangitis complication (P < 0.05). The percentage of antibiotic use and complications in the CP group were significantly less than those in the non-pathway group [adjusted odds ratio (OR) = 0.72, 95% confidence interval (CI): 0.55-0.93, P = 0.012, adjusted OR = 0.44, 95%CI: 0.33-0.59, P < 0.001, respectively]. Patients spent lower costs on hospitalization, operation, nursing, medication, and medical consumable materials (P < 0.001 for all), and even experienced shorter length of hospital stay (LOHS) (P < 0.001) after the CP implementation. No significant differences in clinical outcomes, readmission rate, or secondary surgery rate were presented between the patients in the non-pathway and CP groups.

CONCLUSION

Implementing a CP for patients with CBD stones is a safe mode to reduce the LOHS, hospital costs, antibiotic use, and complication rate.

Keywords: Common bile duct stones, Endoscopic retrograde cholangiopancreatography, Clinical pathway, Outcomes, Costs

Core tip: We utilized a big-data process and application platform for exploring the value of clinical pathway (CP) implementation in patients with common bile duct stones undergoing endoscopic retrograde cholangiopancreatography. Univariate and multivariable regression/linear models were developed to compare the outcomes between the patients in the non-pathway and CP groups. Our findings demonstrated that a CP is a safe mode to reduce the length of hospital stay, hospital costs, antibiotic use, and complication rate. The present study provides big-data evidence for clinical standardization of CPs.