title: Shortened length of stay and hospital cost reduction with implementation of an accelerated clinical care pathway after elective colon resection.
abstract: BACKGROUND
  Patient care pathways have been developed for operative procedures with documented improvements in length of stay and cost without compromising outcome. The average hospital stay after colonic resection is 5 to 10 days. This study describes a clinical pathway for colon resections and examines patient outcome before and after institution of the pathway.
  
  
  METHODS
  One hundred thirty-eight patients underwent elective colon resections at our institution by a single surgeon before (n = 52) and after (n = 86) introduction of a clinical pathway. Length of stay, postoperative complications, readmissions, and cost per patient were compared between the 2 groups.
  
  
  RESULTS
  Mean total length of stay (+/- standard deviation [SD]) was less in the postclinical pathway patients (3.7 +/- 1.5 days) compared to preclinical pathway patients (6.6 +/- 3.3 days) (P <.001). When adjusted for age, sex, diagnosis, and type of operation, the difference in length of stay remains statistically significant (P <.001). There was 1 readmission in the prepathway group and 8 readmissions in the postpathway group. When the readmissions were added to the original admissions, the mean length of stay in the postpathway patients was 4.2 +/- 2.8 days and in the prepathway patients was 6.9 +/- 4.1 days (P <.001). The average cost per patient (+/- standard error of the mean), with readmission costs added, was 9310 +/- 5170 US dollars in the prepathway group and 7070 +/- 3670 US dollars in the postpathway group (P =.002).
  
  
  CONCLUSIONS
  The institution of a clinical pathway for elective, open colon resections can be done safely with improvements in cost and length of stay.
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Boston 02114, USA.
authors.forename: Antonia E
authors.initials: AE
authors.lastname: Stephen
authors.forename: David L
authors.initials: DL
authors.lastname: Berger
mesh_terms: D000328:Adult; D000368:Aged; D001900:Boston; D003082:Colectomy / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D019091:Critical Pathways / Q000191:economics / Q000706:statistics & numerical data; D017558:Elective Surgical Procedures / Q000592:standards; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000191:economics