Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2019 Feb 28;25(8):1002-1011.
doi: 10.3748/wjg.v25.i8.1002.

Big-data analysis: A clinical pathway on endoscopic retrograde cholangiopancreatography for common bile duct stones

Wei Zhang  1 , Bing-Yi Wang  2 , Xiao-Yan Du  2 , Wei-Wei Fang  2 , Han Wu  1 , Lei Wang  1 , Yu-Zheng Zhuge  1 , Xiao-Ping Zou  3
Affiliations
Comparative Study

Big-data analysis: A clinical pathway on endoscopic retrograde cholangiopancreatography for common bile duct stones

Wei Zhang et al. World J Gastroenterol. .

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: Clinical pathway; Common bile duct stones; Costs; Endoscopic retrograde cholangiopancreatography; Outcomes.

PubMed Disclaimer

Conflict of interest statement

Conflict-of-interest statement: The authors have no conflict of interests to declare.

Figures

Figure 1
Figure 1
Flow diagram of study population.
See this image and copyright information in PMC

References

    1. Acalovschi M. Gallstones in patients with liver cirrhosis: Incidence, etiology, clinical and therapeutical aspects. World J Gastroenterol. 2014;20:7277–7285. - PMC - PubMed
    1. Zhu Q, Sun X, Ji X, Zhu L, Xu J, Wang C, Zhang C, Xue F, Liu Y. The association between gallstones and metabolic syndrome in urban Han Chinese: A longitudinal cohort study. Sci Rep. 2016;6:29937. - PMC - PubMed
    1. Anand G, Patel YA, Yeh HC, Khashab MA, Lennon AM, Shin EJ, Canto MI, Okolo PI, Kalloo AN, Singh VK. Factors and Outcomes Associated with MRCP Use prior to ERCP in Patients at High Risk for Choledocholithiasis. Can J Gastroenterol Hepatol. 2016;2016:5132052. - PMC - PubMed
    1. Tazuma S. Gallstone disease: Epidemiology, pathogenesis, and classification of biliary stones (common bile duct and intrahepatic) Best Pract Res Clin Gastroenterol. 2006;20:1075–1083. - PubMed
    1. Aslan F, Arabul M, Celik M, Alper E, Unsal B. The effect of biliary stenting on difficult common bile duct stones. Prz Gastroenterol. 2014;9:109–115. - PMC - PubMed

Publication types

MeSH terms