A clinical pathway for laparoscopically assisted vaginal hysterectomy. Impact on costs and clinical outcome.
OBJECTIVE
To evaluate the cost of and clinical outcome of implementing a clinical pathway for laparoscopically assisted vaginal hysterectomy.


METHODS
A retrospective study of the case records of patients who underwent laparoscopically assisted vaginal hysterectomy before (May-December 1997) and after (January 1998-March 1999) implementation of a clinical pathway. Data regarding resource consumption and clinical outcome represented by 10 clinical indicators were collected. Student's t test and the chi 2 test were used, as appropriate. Statistical significance was set at P = .05.


RESULTS
After implementation of the laparoscopically assisted vaginal hysterectomy clinical pathway, the average total fee decreased significantly, by 8.1% (P = .03), the average inpatient drug fee decreased by 50.6% (P < .01), and the laboratory fee dropped by 56.2% (P < .01). Furthermore, the length of hospital stay significantly decreased, from 6.90 to 4.08 days (P < .01); the average operation time decreased by 24.8% (P < .01); and the average anesthesia time decreased by 21.6% (P < .01). The pre-clinical pathway and post-clinical pathway complication rate did not differ statistically, but the rate of initiating intravenous antibiotic injections > 48 hours following surgery decreased by 76.2% in the clinical pathway group (P = .02).


CONCLUSIONS
Implementation of a clinical pathway for laparoscopically assisted vaginal hysterectomy can improve health care outcomes by decreasing length of hospital stay and admission fees and by maintaining quality of care. The clinical pathway is a good policy for maintaining cost containment and high-quality patient care.
Chang
Wei-Chun
WC
Department of Obstetrics and Gynecology, China Medical College Hospital, and Institute of Health Care Management, China Medical College, Taichung, Taiwan. wei66@iris.seed.net.tw
Lin
Cheng-Chieh
CC
D000328:Adult; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D019091:Critical Pathways; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000191:economics* / Q000379:methods / Q000592:standards*; D015907:Hysteroscopy / Q000191:economics* / Q000592:standards*; D010535:Laparoscopy / Q000191:economics* / Q000592:standards*; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology; D011184:Postoperative Period; D011300:Preoperative Care; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D013624:Taiwan; D016896:Treatment Outcome