Background: Outcome from PD is based not only in the natural history of the disease, but also on patient selection, operative technique, and postoperative care. Multiple studies have focused their attention on the former two factors. The purpose of this study is to evaluate if development of a dedicated multidisciplinary team can increase direct admission to the floor and reduce the ICU admission after PD. Study Design: Between 2005 and 2007, 76 patients underwent a PD by a single surgeon at a non-university tertiary referral center (NUTRC). During the first year 45 PD were preformed and this data was compared with the 31 PD cases performed during the second year. The multidisciplinary team consists of gastroenterologist, surgeon, fellow, resident, ICU nursing staff, operating room team, and a surgery floor nursing staff. Standardized algorithms and a dedicated floor nursing staff were developed during this time period.
Results: Number of patients who suffered some type of complication dropped from 53% to 38% in the second year; Mortality rates remain similar (2.6% compared to 2.2% in year one);Pancreatic fistula rates dropped from 6.6% down to 5.3% at year two;. Mean operative times (240 minutes) and mean blood loss (350 ml) were minimally impacted over the study period. Most importantly, ICU admission after PD dropped from 80% in the first year to 45% in the second year.
Conclusion: This study demonstrates that a multidisciplinary team can be developed in a NUTRC for patients with pancreatic disease. This dedicated process can result in improved outcomes, as measured by complication rate. Importantly, this improved outcome can be achieved with decreased use of the ICU if a dedicated floor nursing team is developed. This decreased utilization of ICU care will translate to decreased hospital charges, earlier mobilization, and a more streamlined pathway for patients after PD.