Effectiveness of the clinical pathway to decrease length of stay and cost for laparoscopic surgery

Background: Although clinical pathways have become popular strategies to improve the quality of medication in the field of laparoscopic surgeries, their economical effectiveness is not well defined. The aim of this study was to investigate the effect of clinical pathways for laparoscopic surgeries on cost and length of hospital stay. Methods: From January 2000 to June 2001, clinical pathways were introduced for laparoscopic surgeries, such as laparoscopic cholecystectomy (Lap. C, n = 210), laparoscopically assisted distal gastrectomy with Billroth-I reconstruction (Lap. B-I, n=33), and laparoscopically assisted colectomy (Lap. colon, n=34). We compared total lengths of hospital stay and the economical efficiency before and after pathway implementation at Wakayama Medical University Hospital. Results: The length of hospital stay in Lap. C was shortened from 7.8±2.6 (mean±SD) days to 6.9±2.0 days (p = 0.03) and the total costs during hospitalization decreased from ¥509,320±58,800 to ¥489,130±43,860 (p=0.009), resulting in less burden for patients. At the same time, the daily costs were increased from ¥66,230±8920 to ¥70,840±6820 (p=0.0001), indicating that more efficient medical care was being given to patients. Similar results were obtained in Lap. B-I and Lap. colon groups. Conclusions: In our study, the implementation of clinical pathways in the field of laparoscopic surgeries produced significant decreases in length of total hospital stay and cost while maintaining the quality of patient outcomes.

Authors and Affiliations

1. Second Department of Surgery, Wakayama Medical University, School of Medicine, 811-1 Kimiidera, Wakayama 641-8510, Japan, Japan

   K. Uchiyama, K. Takifuji, M. Tani, H. Onishi & H. Yamaue

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