Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 28, 2019; 25(8): 1002-1011
Published online Feb 28, 2019. doi: 10.3748/wjg.v25.i8.1002
Big-data analysis: A clinical pathway on endoscopic retrograde cholangiopancreatography for common bile duct stones
Wei Zhang, Bing-Yi Wang, Xiao-Yan Du, Wei-Wei Fang, Han Wu, Lei Wang, Yu-Zheng Zhuge, Xiao-Ping Zou
Wei Zhang, Han Wu, Lei Wang, Yu-Zheng Zhuge, Xiao-Ping Zou, Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
Bing-Yi Wang, Xiao-Yan Du, Wei-Wei Fang, Medical Division, Yidu Cloud (Beijing) Technology Co., Ltd. Beijing 100101, China
Author contributions: Zhang W and Zou XP designed the research; Zhang W, Wang BY, Du XY, Fang WW, Wu H, Wang L, and Zhuge YZ performed the research; Du XY, Fang WW, Wu H, and Wang L analyzed the data; Zhang W, Wang BY, and Zhuge YZ wrote the paper; all authors read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of The Affiliated Drum Tower Hospital of Nanjing University Medical School.
Informed consent statement: Patients were not required to give informed written consent prior to the study because the analysis retrospectively used their clinical data.
Conflict-of-interest statement: The authors have no conflict of interests to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Xiao-Ping Zou, PhD, Professor, Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321, Zhongshan Road, Nanjing 210008, Jiangsu Province, China.
Telephone: +86-13770771661 Fax: +86-25-83106666
Received: December 6, 2018
Peer-review started: December 6, 2018
First decision: January 6, 2019
Revised: January 11, 2019
Accepted: January 18, 2019
Article in press: January 18, 2019
Published online: February 28, 2019
Research background

Endoscopic retrograde cholangiopancreatography (ERCP) is widely recognized as a standard endoscopic technique for patients with common bile duct (CBD) stones. However, ERCP is associated with significant morbidity, mortality, and longer preoperative stay. A clinical pathway (CP) is an advanced methodology that provides a sequence of diagnosis, treatment, and management. Although CP implementation could optimize medical treatment and improve efficiency of medical sources utilization, CP implementation for CBD stones has not been fully promoted at present.

Research motivation

Current situation and value of the CP in management of CBD stones receiving ERCP still need to be explored. With the arrival of the era of big-data, we utilized a big-data process and application platform to provide a solid data base and scientific evidence for the establishment of the CP.

Research objectives

The objective of this study was to compare length of hospital stay (LOHS), costs, clinical outcomes, antibiotic use, and postoperative complication rate before and after implementing a CP for patients with CBD stones undergoing ERCP.

Research methods

Patients with CBD stones from Nanjing Drum Tower Hospital between January 2007 and December 2017 were identified from a big-data, intelligence database platform (Yidu Cloud Technology Ltd., Beijing, China). The enrolled population consisted of two groups which accepted conventional care (non-pathway group, n = 467) and the CP (CP group, n = 2196), respectively. Univariate and multivariable regression/linear models were utilized to compare the medical records and outcomes.

Research results

The percentage of antibiotic use and complications in the CP group were significantly less than those in the non-pathway group [adjusted odds ratio (OR) = 0.72, 95% confidence interval (CI) 0.55-0.93, P = 0.012, adjusted OR = 0.44, 95%CI 0.33-0.59, P < 0.001, respectively]. Patients experienced lower costs in hospitalization, operation, nursing, medication, and materials (P < 0.001 for all), and even shorter LOHS (P < 0.001) after implementation of the CP. No significant differences in clinical outcomes, readmission rate, or secondary surgery rate were presented between the patients in non-pathway and CP groups.

Research conclusion

In conclusion, implementation of the CP for patients with CBD stones undergoing ERCP significantly reduced LOHS, the costs, the rate of antibiotic use, and the incidence of complications without increasing readmission rates. A CP is confirmed to be an effective mode which is explicit about the sequencing, timing, and provision of interventions in the field of CBD stones. Meanwhile, our study provides further big-data evidence of a multidisciplinary CP in Chinese patients.

Research perspectives

Despite that this is the rare big-data evidence of a CP in Chinese patients with CBD stones, further multiple-center studies with larger variable are essential to strengthen the results.