Impact of clinical pathways in surgery.

Details

Serval ID
serval:BIB_AE3ACF4EE4F7
Type
Article: article from journal or magazin.
Collection
Publications
Title
Impact of clinical pathways in surgery.
Journal
Langenbeck's Archives of Surgery
Author(s)
Müller M.K., Dedes K.J., Dindo D., Steiner S., Hahnloser D., Clavien P.A.
ISSN
1435-2451 (Electronic)
ISSN-L
1435-2443
Publication state
Published
Issued date
2009
Volume
394
Number
1
Pages
31-39
Language
english
Notes
Publication types: Comparative Study ; Journal ArticlePublication Status: ppublish
Abstract
BACKGROUND: 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.
METHOD: 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).
RESULTS: 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 euro 6,390 to euro 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 euro 1,810 to euro 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).
CONCLUSIONS: 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.
Keywords
Adult, Cholecystectomy, Laparoscopic/economics, Cholecystectomy, Laparoscopic/nursing, Cost Savings/statistics & numerical data, Cost-Benefit Analysis/statistics & numerical data, Critical Pathways/economics, Critical Pathways/standards, Diagnostic Tests, Routine/economics, Female, Gastric Bypass/economics, Gastric Bypass/standards, Health Care Costs/statistics & numerical data, Health Resources/economics, Health Resources/utilization, Hernia, Inguinal/economics, Hernia, Inguinal/nursing, Hospital Costs/statistics & numerical data, Hospitals, Teaching/economics, Humans, Laparoscopy/economics, Laparoscopy/standards, Length of Stay/economics, Male, Middle Aged, National Health Programs/economics, Nursing Staff, Hospital/economics, Nursing Staff, Hospital/utilization, Patient Readmission/economics, Pilot Projects, Postoperative Complications/economics, Postoperative Complications/nursing, Prospective Studies, Switzerland, Utilization Review/statistics & numerical data
Pubmed
Web of science
Create date
07/10/2014 15:22
Last modification date
20/08/2019 16:18
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