Evaluation of the Critical Pathway for Laparoscopic Cholecystectomy from the Perspective of Pain Course

Abstract

Purpose: The critical pathway is a standardized practice guideline for providing quality healthcare. It improves patient outcomes by providing comprehensive treatment. Although many studies have explored the effectiveness of the critical pathway in laparoscopic cholecystectomy, no study has reported how it affects pain levels during a patient's hospital stay. This study aimed to evaluate the effectiveness of the critical pathway in reducing pain severity. Methods: Between January 2022 and December 2023, 723 patients underwent laparoscopic cholecystectomy. The patients were categorized into two groups: 407 patients in the critical pathway group and 316 in the non-critical pathway group. Patient outcomes, namely the length of hospital stay, postoperative hospital stay, total healthcare cost, unplanned emergency room visits within 30 days, pain score, and number of analgesics administered, were analyzed and compared between the groups. Results: The length of hospital stay was 3.43 ± 1.02 and 3.73 ± 1.78 days for the critical pathway and non-critical pathway groups, respectively (p=.007). The total healthcare cost was 3981.77 ± 747.02 US$ and 4929.10 ± 1710.33 US$ for the critical pathway and non-critical pathway, respectively (p<.001). No significant difference was observed in unplanned 30-day emergency room visits between the two groups. The average pain during the hospital stay was 3.17 ± 0.68 and 3.29 ± 0.75 points in the critical pathway and non-critical pathway groups, respectively (p=.023). Conclusion: The critical pathway is an effective protocol for achieving rapid postoperative recovery. The results showed that reduced pain and faster discharge are possible through the critical pathway. In addition, despite the shorter hospitalization period in the critical pathway group, no significant difference was observed in unplanned 30-day emergency room visits between the two groups. This is a promising outcome for the widespread application of the critical pathway in laparoscopic cholecystectomy.