Effects Of Clinical Pathways In Laparoscopic Cholecystectomy: A Meta-analysis

BACKGROUND:Laparoscopic cholecystectomy (LC) is one of the most frequent abdominal surgical procedures with a predictable clinical course that is ideal for commencing the implementation of a clinical pathway in general surgery. We performed a meta-analysis to evaluate the use of clinical pathways for laparoscopic cholecystectomy compared with standard medical care. The effect of implementing a clinical pathway was evaluated in terms of length of stay (LOS), hospital costs, and patient outcomes.METHODS:We searched the databases of Medline, Embase, the Cochrane Central Register of Controlled Trials, and CBD (China Biomedical Literate Database). We searched reference lists of relevant articles and important meeting articles that were not published. Only randomized controlled trials (RCTs) and controlled clinical trials (CCTs) that were published from 1980 to 2011 were included, without restrictions by language or country of publication. Two reviewers performed the evaluation independently and the data analysis was performed using the RevMan software (ver.5.0).RESULTS:Seven trials met the inclusion criteria, representing 1187 patients. Patients with LC in a clinical pathway had a shorter hospital stay (weighted mean difference (WMD)=-1.90; 95% confidence interval (CI)= (-)2.65-(-)1.16 days; P< 0.00001) and spent less money (standardized mean difference (SMD)=-0.99; 95%CI= (-)1.51- (-)0.47; P< 0.00001), while enjoying better medical services (patients indicated better responses on satisfaction questionnaires).CONCLUSIONS:From this analysis, we confirmed that the total LOS and costs were effectively reduced through the implementation of a clinical pathway for LC. However, the evidence is not sufficiently conclusive to prove differences in postoperative complications. Future research should focus on patients'outcomes, aiming to identify the active factors in which the clinical pathway actually works.