Impact of clinical pathways in surgery
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One strategy to reduce the consumption of resources associated to specific procedures is to utilize clinical pathways, in which surgical care is standardized and preset by determination of perioperative in-hospital processes. The aim of this prospective study was to establish the impact of clinical pathways on costs, complication rates, and nursing activities.
Data was prospectively collected for 171 consecutive patients undergoing laparoscopic cholecystectomy (n = 50), open herniorrhaphy (n = 56), and laparoscopic Roux-en-Y gastric bypass (n = 65).
Clinical pathways reduced the postoperative hospital stay by 28% from a mean of 6.1 to 4.4 days (p < 0.001), while the 30-day readmission rate remained unchanged (0.5% vs. 0.45%). Total mean costs per case were reduced by 25% from € 6,390 to € 4,800 (p < 0.001). Costs for diagnostic tests were reduced by 33% (p < 0.001). Nursing hours decreased, reducing nursing costs by 24% from € 1,810 to € 1,374 (p < 0.001). A trend was noted for lower postoperative complication rates in the clinical pathway group (7% vs. 14%, p = 0.07).
This study demonstrates clinically and economically relevant benefits for the utilization of clinical pathways with a reduction in use of all resource types, without any negative impact on the rate of complications or re-hospitalization.
KeywordsClinical pathways Cost reduction Surgery
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- 1.Bundesamt für Statistik: Gesundheitskosten in der Schweiz: Bundesamt für Statistik. www.bfs.admin.ch/bfs/portal/de/index/themen/gesundheit.html 2007
- 6.Archer SB, Burnett RJ, Flesch LV, Hobler SC, Bower RH, Nussbaum MS et al (1997) Implementation of a clinical pathway decreases length of stay and hospital charges for patients undergoing total colectomy and ileal pouch/anal anastomosis. Surgery 122(4):699–703, discussion 703–705PubMedCrossRefGoogle Scholar
- 28.(1997) Lap choly pathway leads to efficiency, savings. Hosp Case Manag 5(7):125–128Google Scholar
- 32.Eagle KA, Berger PB, Calkins H, Chaitman BR, Ewy GA, Fleischmann KE et al (2002) ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery—executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). J Am Coll Cardiol 39(3):542–553PubMedCrossRefGoogle Scholar