The effects of a pediatric unilateral inguinal hernia clinical pathway on quality and cost.
OBJECTIVE
The purpose of this study is to discover whether a pediatric inguinal hernia surgical clinical pathway (CP) reduces the frequency of wound infections, return visits, times associated with surgical repair, or costs.


METHODS
A multidisciplinary team developed the inguinal hernia surgical clinical pathway. Healthy children greater than 50 weeks gestational age who required unilateral hernia repair were considered for the study. Two groups were formed: (1) an intervention group selected randomly (n = 46, CI = 95%, power = .80) from patients enrolled from November 1996 through April 1997, and (2) a retrospective cohort control group (n = 46) matched to each intervention patient by age, gender, and medical history. Analysis of variance and chi2 testing were used to test for significant differences between the 2 groups in postoperative wound infections, readmission and emergency department return visits within 72 hours, times associated with surgical repair, and costs.


RESULTS
There were no significant differences in postoperative wound infections, times associated with surgical repair, or readmission rates within 72 hours. Total cost significantly decreased, by 10% (P< or = .05), for pathway patients ($982 v $880).


CONCLUSIONS
These results show that the use of a pediatric inguinal hernia surgical clinical pathway is associated with reduced cost while maintaining quality of care.
Department of Surgery, Eastern Virginia Medical School, Children's Hospital of The King's Daughters, Norfolk 23507, USA.
R E
RE
Kelly
A
A
Wenger
C
C
Horton
D
D
Nuss
D P
DP
Croitoru
J P
JP
Pestian
D002675:Child, Preschool; D003365:Costs and Cost Analysis; D019091:Critical Pathways; D005260:Female; D006552:Hernia, Inguinal / Q000191:economics* / Q000601:surgery*; D006801:Humans; D008297:Male; D010359:Patient Readmission; D011787:Quality of Health Care; D012189:Retrospective Studies