Improving Pancreatectomy Care in a State-Wide Quality Collaborative: A Brief Review

Background: Pancreatectomies are among the most morbid operations performed in Michigan and they carry significant variation in outcomes postoperatively with regards to complication, readmission and reoperation rates as well as hospital length of stay. Here we demonstrate how findings from The Michigan Surgical Quality Collaborative (MSQC), a collaborative of Michigan Hospitals dedicated to surgical quality improvement, have constructed a pancreatectomy clinical care pathway capable of improving pancreatectomy outcomes. Materials & Methods: The pancreatectomy care pathway we propose is a compilation of current pathways or guidelines currently in use at peer institutions, reviewed and edited by surgeon representatives to generate a consensus pathway categorized by phase: preoperative, immediate preoperative, intraoperative, postoperative and post-discharge. Each phase focuses on various aspects of clinical care that could be standardized across hospitals and implemented to improve quality of patient care. Results: Outcomes we discuss include hospital length of stay, spending, pathway implementation and the limitation of outcome markers such as complications, morbidity and mortality. Barriers to this pathway are included as well. Conclusions: By outlining our pancreatectomy pathway and its potential benefits, we aim to demonstrate the importance of implementing this pathway in hospitals across the state of Michigan. Using this pathway as an example, we hope to impress upon others the need to utilize care pathways in order to optimize systems of pancreatectomy care universally.