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Introduction: Pancreaticoduodenectomy (PD) is a complex procedure with historically high rates of morbidity but can be performed efficiently at high volume centers. Clinical pathways increase efficiency for multiple operations including PD and have been shown to decrease length of stay and cost of PD at academic institutions. Our goal was to study implementation of a clinical pathway for PD at a rural tertiary care center to determine if length of stay decreased post implementation.

Methods: Patient outcomes prior to and following implementation of a PD clinical pathway were studied between January 2006 and February 2011. Thirty five patients underwent PD prior to implementation of the clinical pathway and twenty two underwent PD after implementation. Primary outcomes included hospital length of stay and intensive care unit length of stay; operative time and estimated blood loss were analyzed as well. The pathway consists of pre-established daily goals; implementation began at the pre-operative visit and goals were set for the operative and the post-operative course.

Results: The two groups were well matched in terms of age, gender, BMI, and histology. The primary outcome was length of stay, determined to be 14 days prior to pathway implementation and 7 days following pathway implementation (p < 0.0001). Operative time was also statistically shorter in the pathway group. There was no statistically significant difference in length of intensive care unit stay between the two groups.

Conclusion: Implementation of a clinical pathway for PD is possible at a rural tertiary care center. Following our pathway led to more reproducible post operative care. At our institution this pathway led to a decrease in length of stay and thereby improved short term patient outcomes.