الفهرس 
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Abstract
Vulvular heart replacement surgery is the most commonly performed major surgical procedure. Knowledge and technological advancement give rise to further challenge for nurses caring for these patients. The role of the professional nurse in the perioperative care of the patient undergoing open heart surgery is beneficial for obtaining a positive outcome for the patient. With an era of increasing competition in medical care, clinical pathway guidelines have emerged as one of the most popular new initiatives intended to reduce costs while maintaining or even improving the quality of care. Developed primarily for high-volume hospital diagnoses, clinical pathways display goals for patients and provide the corresponding ideal sequence and timing of staff actions for achieving those goals with optimal efficiency.
The aim of the current clinical path is to determine the outcome of implementing a clinical pathway for patients undergoing valvular heart replacement surgery. Where, the key outcomewas to decrease the hospital length of stay (LOS), return to the operating room, readmission to the hospital , complications , subsequently decreasing costs while increasing patients’ satisfaction. The current clinical path compared the control group that underwent the routine hospital schedule and clinical path group (pathway group), which followed a preset pathway checklist. This clinical path was conducted at Cardiothoracic Surgery Unit at the Mansoura University Hospital Data collection took approximately 12 months.
The results of present study demonstrate that there were no statistical significant differences in basic data upon admission between the clinical path group and control group which including age, gender, marital status, level of education, and occupation were statistically not significant. As for preoperative risk factors including patient’s history of smoking, smoking duration, chronic obstructive pulmonary disease, hypertension, hyperglycemia, pulmonary hypertension and previous cardiac surgery, there was no significant correlation between the preoperative modifiable risk factors and each of control and CP group. In relation to the intraoperative risk factors including cardiopulmonary bypass machine (CPB) machine time, aortic cross clamping time, and the involved valve, there was a statistically significant difference between both groups regarding their time on CPB machine as the time decreased from 92.2±21.8 minutes to 79.12±23 minutes in the clinical path group. On the other hand, no significant difference between both groups regarding aortic cross-clamping time, and the involved valves. Regarding the length of stay that the patient spent both in intensive care unit and hospital, it was found that the mean of hospital length of stay in control group was 8.56±2.599 days decreased to 6.24±0.523 days in the clinical path group.
Conclusion: Clinical pathway lessened the postoperative length of hospital stay, readmission to operating room and hospital readmission in the CP group compared to the control group. Clinical pathway implementation has positive effect on improving respiratory clinical outcome evidenced by gas exchange indicators (partial pressure of arterial carbon dioxide, and oxygen saturation of artery) in postoperative period after vulvular surgery.