Effects of a Clinical Pathway on Quality of Care in Kidney Transplantation: a Non-randomized Clinical Trial

Overview

Journal Langenbecks Arch Surg

Specialty General Surgery

Date 2009 Sep 19

PMID 19763604

Citations 13

Authors

Matthias Schwarzbach

Roderich Bonninghoff

Katrin Harrer

Johannes Weiss

Christof Denz

Peter Schnulle

Rainer Birck

Stefan Post

Ulrich Ronellenfitsch

Affiliations

Soon will be listed here.

Abstract

Purpose: Standardization of care is essential for improving outcome of kidney transplantation (KT). Clinical pathways (CPs) are known to standardize and improve perioperative care for a number of interventions. In transplantation medicine, however, pertinent evidence is very limited. This study evaluates effects of a CP on quality of care in KT.

Materials And Methods: Consecutive patients (n=32) undergoing KT between July 2006 and August 2007 who were treated with a CP were compared to patients (n=44) treated without CP between January 2005 and June 2006. Several quality indicators regarding process and outcome were compared between groups.

Results: Quality of care was significantly higher in the CP group for the following indicators: timely removal of central venous catheters, wound drains, and Foley catheters and control of cyclosporine levels, respiratory exercising, and pain control. Median stay decreased non-significantly from 21.4 to 18.3 days. There was significantly less delayed graft function in the CP group. All other outcome indicators showed no significant differences.

Conclusions: Implementation of a CP for KT improves the quality of perioperative treatment by standardizing care. Regarding effects on outcome, no clear conclusion can be drawn. We recommend that large randomized studies are conducted to evaluate the latter issue.

Citing Articles

Investigation of Different Methods of Intraoperative Graft Perfusion Assessment during Kidney Transplantation for the Prediction of Delayed Graft Function: A Prospective Pilot Trial.

Gerken A, Keese M, Weiss C, Krucken H, Pecher K, Ministro A J Pers Med. 2022; 12(10).

PMID: 36294888 PMC: 9605219. DOI: 10.3390/jpm12101749.

Enhanced Recovery after Renal Transplantation Decreases Recipients' Urological Complications and Hospital Stay: A Systematic Review and Meta-Analysis.

Prionas A, Craddock C, Papalois V J Clin Med. 2021; 10(11).

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The effectiveness of an oral opioid rescue medication algorithm for postoperative pain management compared to PCIA : A cohort analysis.

Erlenwein J, Emons M, Petzke F, Quintel M, Staboulidou I, Przemeck M Anaesthesist. 2020; 69(9):639-648.

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Clinical Pathways for Oncological Gastrectomy: Are They a Suitable Instrument for Process Standardization to Improve Process and Outcome Quality for Patients Undergoing Gastrectomy? A Retrospective Cohort Study.

Teoule P, Birgin E, Mertens C, Schwarzbach M, Post S, Rahbari N Cancers (Basel). 2020; 12(2).

PMID: 32069805 PMC: 7073178. DOI: 10.3390/cancers12020434.

Clinical Pathways For Pancreatic Surgery: Are They A Suitable Instrument For Process Standardization To Improve Process And Outcome Quality Of Patients Undergoing Distal And Total Pancreatectomy? - A Retrospective Cohort Study.

Teoule P, Romling L, Schwarzbach M, Birgin E, Ruckert F, Wilhelm T Ther Clin Risk Manag. 2019; 15:1141-1152.

PMID: 31632041 PMC: 6778449. DOI: 10.2147/TCRM.S215373.

References

van der Weide M, Hilbrands L, Bemelmans B, Meuleman E, Frederiks C . Lower urinary tract symptoms after renal transplantation. J Urol. 2001; 166(4):1237-41. DOI: 10.1097/00005392-200110000-00005. View

Holtzman J, Bjerke T, Kane R . The effects of clinical pathways for renal transplant on patient outcomes and length of stay. Med Care. 1998; 36(6):826-34. DOI: 10.1097/00005650-199806000-00006. View

Stiller K, Munday R . Chest physiotherapy for the surgical patient. Br J Surg. 1992; 79(8):745-9. DOI: 10.1002/bjs.1800790807. View

Zoccali C, Abramowicz D, Cannata-Andia J, Cochat P, Covic A, Eckardt K . European best practice quo vadis? From European Best Practice Guidelines (EBPG) to European Renal Best Practice (ERBP). Nephrol Dial Transplant. 2008; 23(7):2162-6. DOI: 10.1093/ndt/gfn238. View

Humar A, Johnson E, Gillingham K, Sutherland D, Payne W, Dunn D . Venous thromboembolic complications after kidney and kidney-pancreas transplantation: a multivariate analysis. Transplantation. 1998; 65(2):229-34. DOI: 10.1097/00007890-199801270-00015. View

Humar A, Matas A . Surgical complications after kidney transplantation. Semin Dial. 2006; 18(6):505-10. DOI: 10.1111/j.1525-139X.2005.00097.x. View

Curtis L . Prevention of hospital-acquired infections: review of non-pharmacological interventions. J Hosp Infect. 2008; 69(3):204-19. PMC: 7172535. DOI: 10.1016/j.jhin.2008.03.018. View

Delaney C, Zutshi M, Senagore A, Remzi F, Hammel J, Fazio V . Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection. Dis Colon Rectum. 2003; 46(7):851-9. DOI: 10.1007/s10350-004-6672-4. View

Donabedian A . The quality of care. How can it be assessed?. JAMA. 1988; 260(12):1743-8. DOI: 10.1001/jama.260.12.1743. View

10.

Schold J, Srinivas T, Howard R, Jamieson I, Meier-Kriesche H . The association of candidate mortality rates with kidney transplant outcomes and center performance evaluations. Transplantation. 2008; 85(1):1-6. DOI: 10.1097/01.tp.0000297372.51408.c2. View

11.

Axelrod D, Guidinger M, McCullough K, Leichtman A, Punch J, Merion R . Association of center volume with outcome after liver and kidney transplantation. Am J Transplant. 2004; 4(6):920-7. DOI: 10.1111/j.1600-6143.2004.00462.x. View

12.

. Renal transplantation path saves $34K per patient. Hosp Case Manag. 1999; 7(1):5-8. View

13.

Cecka M . Clinical outcome of renal transplantation. Factors influencing patient and graft survival. Surg Clin North Am. 1998; 78(1):133-48. DOI: 10.1016/s0039-6109(05)70639-3. View

14.

Abecassis M, Bartlett S, Collins A, Davis C, Delmonico F, Friedewald J . Kidney transplantation as primary therapy for end-stage renal disease: a National Kidney Foundation/Kidney Disease Outcomes Quality Initiative (NKF/KDOQITM) conference. Clin J Am Soc Nephrol. 2008; 3(2):471-80. PMC: 2390948. DOI: 10.2215/CJN.05021107. View

15.

Knoll G . Trends in kidney transplantation over the past decade. Drugs. 2008; 68 Suppl 1:3-10. DOI: 10.2165/00003495-200868001-00002. View

16.

Lied T, Kazandjian V . A Hawthorne strategy: implications for performance measurement and improvement. Clin Perform Qual Health Care. 1999; 6(4):201-4. View

17.

Ronellenfitsch U, Rossner E, Jakob J, Post S, Hohenberger P, Schwarzbach M . Clinical Pathways in surgery: should we introduce them into clinical routine? A review article. Langenbecks Arch Surg. 2008; 393(4):449-57. DOI: 10.1007/s00423-008-0303-9. View

18.

Gjertson D . Center and other factor effects in recipients of living-donor kidney transplants. Clin Transpl. 2002; :209-21. View

19.

Beyga Z, Kahan B . Surgical complications of kidney transplantation. J Nephrol. 1998; 11(3):137-45. View

20.

Cushing K, Stratta R . Design, development, and implementation of a critical pathway in simultaneous pancreas-kidney transplant recipients. J Transpl Coord. 1998; 7(4):164-72. DOI: 10.7182/prtr.1.7.4.85t3h0px60466773. View