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Cost-effectiveness of Clinical Pathway in Coronary Artery Bypass Surgery

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Abstract

Few studies have been devoted to the exploration of the effect of clinical pathways on coronary artery diseases treated with coronary artery bypass (CAB) surgery. This study was aimed to investigate the cost and effectiveness of the clinical pathway on CAB surgery in a medical center. With a retrospective dataset in 2003–2007, 212 CAB surgery patients were included. Data of the costs and postoperative complication occurrence and length of stays were the focus and patient demographics, surgical risk indicator EuroSCORE, surgical conditions were collected. It revealed that there was differentiation across specified cost items in beating heart CAB surgery patients, but not for heart arrest CAB surgery patients with and without clinical pathways enrolled. In addition, there was no difference in postoperative complication occurrence in CAB surgery patients enrolled into clinical pathways. However, robotic beating heart CAB surgery patients enrolled clinical pathways were shown to have less postoperative ordinary ward stay than those not enrolled clinical pathways. CAB surgery patients’ age and surgical risks were related to their postoperative lengths of stay to some extent.

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References

  1. Battista, R. N., and Hodge, M. J., Clinical practice guidelines: between science and art. Can. Med. Assoc. J. 148:385–8, 1993.

    Google Scholar 

  2. Gilmore, A., Clinical practice guidelines: weapons for patients, or shields for MDs. Can. Med. Assoc. J. 148:429–431, 1993.

    Google Scholar 

  3. Hayward, R. S. A., and Laupacis, A., Initiating, conducting and maintaining guidelines development programs. Can. Med. Assoc. J. 148:507–512, 1993.

    Google Scholar 

  4. DeSomma, M., Divekar, A., Galloway, A. C., Colvin, S. B., Artman, M., and Auslender, M., Impact of a clinical pathway on the postoperative care of children undergoing surgical closure of atrial septal defects. Appl. Nurs. Res. 15 (4)243–248, 2002.

    Article  Google Scholar 

  5. National Heart Attack Alert Program (NHAAP) coordinating committee critical pathways writing group, Critical pathways for management of patients with acute coronary syndromes: an assessment by the National Heart Attack Alert Program. Am. Heart J. 143:777–789, 2002.

    Article  Google Scholar 

  6. Ranjan, A., Tarigopula, L., Srivastava, R. K., Obasanjo, O. O., and Obah, E., Effectiveness of the clinical pathway in the management of congestive heart failure. South. Med. J. 96 (7)661–663, 2003.

    Article  Google Scholar 

  7. Pearson, S. D., Kleefield, S. F., Soukop, J. R., Cook, E. F., and Lee, T. H., Critical pathways intervention to reduce length of hospital stay. Am. J. Med. 110 (3)175–80, 2001.

    Article  Google Scholar 

  8. Barnes, R. V., Lawton, L., and Briggs, D., Clinical benchmarking improves clinical paths: experience with coronary artery bypass grafting. Joint Comm. J. Qual. Improv. 20 (5)267–276, 1994.

    Google Scholar 

  9. Rumble, S. J., Jernigan, M. H., and Rudisill, P. T., Determining the effectiveness of critical pathways for coronary artery bypass graft patients: retrospective comparison of readmission rates. J. Nurs. Care Qual. 11 (2)34–40, 1996.

    Google Scholar 

  10. Dy, S. M., Garg, P., Nyberg, D., Dawson, P. B., Pronovost, P. J., Morlock, L., Rubin, H., and Wu, A. W., Critical pathway effectiveness: assessing the impact of patient, hospital care, and pathway characteristics using qualitative comparative analysis. Health Serv. Res. 40 (2)499–516, 2005.

    Article  Google Scholar 

  11. Davis, J. T., Allen, H. D., Felver, K., Rummell, H. M., Powers, J. D., and Cohen, D. M., Clinical pathways can be based on acuity, not diagnosis. Ann. Thorac. Surg. 59:1074–1078, 1995.

    Article  Google Scholar 

  12. Ibarra, V. L., Mueller, T., Rossi, N., Schillig, K., and Swearingen, J., Interdisciplinary quality improvement from the perspective of a clinical pathway team. J. Nurs. Care Qual. 12 (3)19–29, 1998.

    Google Scholar 

  13. Williams, M. L., Muhlbaier, L. H., Schroder, J. N., Hata, J. A., Peterson, E. D., Smith, P. K., Landolfo, K. P., Messier, R. H., Davis, R. D., and Milano, C. A., Risk-adjusted short- and long-term outcomes for on-pump versus off-pump coronary artery bypass surgery. Circulation (Cardiovascular Surgery Supplement). 112 (9 Supplement)1366–1370, 2005.

    Google Scholar 

  14. Bolton, J. E. R., and Connally, J. E., Results of a phase one study on robotically assisted myocardial revascularization on the beating heart. Ann. Thorac. Surg. 78:154–158, 2004.

    Article  Google Scholar 

  15. Kirk, K. C., Aldridge, R. A., Sistino, J. J., Zellner, J. L., Crumbley, A. J., Kratz, J. M., Crawford, F. A. Jr., and Reeves, S. T., Coronary artery bypass grafting with and without cardiopulmonary bypass: a comparison analysis. J. Extra-Corpor. Technol. 33 (2)86–90, 2001.

    Google Scholar 

  16. Sedrakyan, A., Wu, A. W., Parashar, A., Bass, E. B., and Treasure, T., Off-pump surgery is associated with reduced occurrence of stroke and other morbidity as compared with traditional coronary artery bypass grafting: a meta-analysis of systematically reviewed trials. Stroke. 37 (11)2759–2769, 2006.

    Article  Google Scholar 

  17. Järvinen, O., Huhtala, H., Laurikka, J., and Tarkka, M. R., Higher age predicts adverse outcome and readmission after coronary artery bypass grafting. World J. Surg. 27 (12)1317–1322, 2003.

    Article  Google Scholar 

  18. Paone, G., Higgins, R. S., Havstad, S. L., and Silverman, N. A., Does age limit the effectiveness of clinical pathways after coronary artery bypass graft surgery. Circulation. 98 (19 Suppl)II41–II45, 1998.

    Google Scholar 

  19. Roscitano, A., Benedetto, U., Capuano, F., Simon, C., Tonelli, E., Ruvolo, G., and Sinatra, R., Off-pump versus on-pump coronary artery bypass: does number of grafts performed represent a selection bias in comparative studies? Results from a matched cohort comparison. Ital. Heart J. 6 (9)740–744, 2005.

    Google Scholar 

  20. Becker, E. R., and Rahimi, A., Disparities in race/ethnicity and gender in in-hospital mortality rates for coronary artery bypass surgery patients. J. Natl. Med. Assoc. 98 (11)1729–1739, 2006.

    Google Scholar 

  21. Steuer, J., Blomqvist, P., Granath, F., Rydh, B., Ekbom, A., de Faire, U., and Ståhle, E., Hospital readmission after coronary artery bypass grafting: are women doing worse? Ann. Thorac. Surg. 73 (5)1380–1386, 2002.

    Article  Google Scholar 

  22. D’Errigo, P., Seccareccia, F., Rosato, S., Manno, V., Badoni, G., Fusco, D., and Perucci, C. A., Comparison between an empirically derived model and the EuroSCORE system in the evaluation of hospital performance: the example of the Italian CABG Outcome Project. Eur. J. Cardio-Thorac. Surg. 33:325–333, 2008.

    Article  Google Scholar 

  23. Gogbashian, A., Sedrakyan, A., and Treasure, T., EuroSCORE: a systematic review of international performance. Eur. J. Cardio-Thorac. Surg. 25:695–700, 2004.

    Article  Google Scholar 

  24. Toumpoulis, I. K., Anagnostopoulos, C. E., DeRose, J. J., and Swistel, D. G., Does EuroSCORE predict length of stay and specific postoperative complications after cardiac surgery. Eur. J. Cardio-Thorac. Surg. 27:128–133, 2005.

    Article  Google Scholar 

  25. Youn, Y. N., Kwak, Y. L., and Yoo, K. J., Can the EuroSCORE predict the early and mid-term mortality after off-pump coronary artery bypass grafting. Ann. Thorac. Surg. 83 (6)2111–2117, 2007.

    Article  Google Scholar 

  26. Anderson, B., Higgins, L., and Rozmus, C., Critical pathways: application to selected patient outcomes following coronary artery bypass graft. Appl. Nurs. Res. 12 (4)168–174, 1999.

    Article  Google Scholar 

  27. van Mastrigt, G. A., Heijmans, J., Severens, J. L., Fransen, E. J., Roekaerts, P., Voss, G., and Maessen, J. G., Short-stay intensive care after coronary artery bypass surgery: randomized clinical trial on safety and cost-effectiveness. Crit. Care Med. 34 (1)65–75, 2006.

    Article  Google Scholar 

  28. Scott, B. H., Seifert, F. C., Grimson, R., and Glass, P. S., Resource utilization in on- and off-pump coronary artery surgery: factors influencing postoperative length of stay—an experience of 1,746 consecutive patients undergoing fast-track cardiac anesthesia. J. Cardiothorac. Vasc. Anesth. 19 (1)26–31, 2005.

    Article  Google Scholar 

  29. Curtis, L. H., Phelps, C. E., McDermott, M. P., and Rubin, H. R., The value of patient-reported health status in predicting short-term outcomes after coronary artery bypass graft surgery. Med. Care. 40 (11)1090–1100, 2002.

    Google Scholar 

  30. Cowper, P. A., DeLong, E. R., Hannan, E. L., Muhlbaier, L. H., Lytle, B. L., Jones, R. H., Holman, W. L., Pokorny, J. J., Stafford, J. A., Mark, D. B., and Peterson, E. D., Trends in postoperative length of stay after bypass surgery. Am. Heart J. 152 (6)1194–1200, 2006.

    Article  Google Scholar 

  31. Kim, S., Losina, E., Solomon, D. H., Wright, J., and Katz, J. N., Effectiveness of clinical pathways for total knee and total hip arthroplasty: literature review. J. Arthroplast. 18 (1)69–74, 2003.

    Article  Google Scholar 

  32. Chang, P. L., Wang, T. M., Huang, S. T., Hsieh, M. L., Chuang, Y. C., and Chang, C. H., Improvement of health outcomes after continued implementation of a clinical pathway for radical nephrectomy. World J. Urol. 18 (6)417–421, 2000.

    Article  Google Scholar 

  33. Hannan, E. L., Racz, M. J., Walford, G., Ryan, T. J., Isom, O. W., Bennett, E., and Jones, R. H., Predictors of readmission for complications of coronary artery bypass graft surgery. JAMA. 290 (6)773–780, 2000.

    Article  Google Scholar 

  34. Broder, M. S., and Bovone, S., Improving treatment outcomes with a clinical pathway for hysterectomy and myomectomy. J. Reprod. Med. 47 (12)999–1003, 2000.

    Google Scholar 

  35. CABG path yields savings, but proves ‘user unfriendly’. Hosp. Case Manag. 5(7):129–123, 1997.

    Google Scholar 

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Acknowledgement

This study was supported by Taichung Veterans General Hospital for provisions of administrative and medical data.

Author information

Authors and Affiliations

  1. Division of Cardiovascular Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China

    Yung-Kai Lin

  2. Department of Business Administration, National Chung Hsing University, Taichung, Taiwan, Republic of China

    Chia-Pin Chen & Yu-Ching Chiao

  3. Department of Health Services Administration, China Medical University, Taichung, Taiwan, Republic of China

    Wen-Chen Tsai & Blossom Yen-Ju Lin

Authors
  1. Yung-Kai Lin
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  2. Chia-Pin Chen
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  3. Wen-Chen Tsai
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  4. Yu-Ching Chiao
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  5. Blossom Yen-Ju Lin
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Corresponding author

Correspondence to Blossom Yen-Ju Lin.

Appendices

Appendix 1 Design of clinical pathway for coronary artery bypass surgery in the studied medical center

Part I. Preoperative preparation
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Part II. Operation and postoperative pathway
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Appendix 2 Criteria excluded from clinical pathways for CAB surgery patients proposed by Bureau of National Health Insurance

   
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Lin, YK., Chen, CP., Tsai, WC. et al. Cost-effectiveness of Clinical Pathway in Coronary Artery Bypass Surgery. J Med Syst 35, 203–213 (2011). https://doi.org/10.1007/s10916-009-9357-7

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  • DOI: https://doi.org/10.1007/s10916-009-9357-7

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