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Impact of clinical pathways in surgery

Müller, Markus ; Dedes, Konstantin ; Dindo, Daniel ; Steiner, Stefan ; Hahnloser, Dieter ; Clavien, Pierre-Alain

In: Langenbeck's Archives of Surgery, 2009, vol. 394, no. 1, p. 31-39

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    Title
    • Impact of clinical pathways in surgery
    Author
    • Müller, Markus. Department of Surgery, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
    • Dedes, Konstantin. Department of Surgery, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
    • Dindo, Daniel. Department of Surgery, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
    • Steiner, Stefan. Department of Surgery, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
    • Hahnloser, Dieter. Department of Surgery, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
    • Clavien, Pierre-Alain. Department of Surgery, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
    Document Type
    • Postprint
    OAI-PMH Identifier
    • oai:doc.rero.ch:314144
    Summary
    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 4.4days (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). 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