title: Outpatient laparoscopic cholecystectomy: clinical pathway implementation is efficient and cost effective and increases hospital bed capacity.
abstract: BACKGROUND
  Outpatient laparoscopic cholecystectomy (OLC) may decrease the use of hospital resources and save costs. In the current study, the effect of implementing a clinical pathway has been assessed in terms of outcome for patients scheduled to undergo laparoscopic cholecystectomy, hospital costs, and available bed capacity.
  
  
  METHODS
  Clinical outcome and hospital stay were analyzed for consecutive patients scheduled to undergo laparoscopic cholecystectomy 1 year before (n = 338) and after (n = 336) implementation of a clinical pathway. Patients with acute cholecystitis or bile duct lithiasis were excluded from the study. A cost accounting model was developed using the concept of the bill of activities.
  
  
  RESULTS
  Before implementation of the clinical pathway, 34 (94%) of 36 patients scheduled for OLC were discharged successfully on the day of surgery, as compared with 110 (94%) of 117 patients after pathway implementation. Among patients scheduled for OLC, the complication (0% vs 1.7%), unplanned admission (5.5% vs 6%), and readmission (0% vs 4.3%) rates were comparable before and after clinical pathway implementation. After pathway implementation, the increased number of OLCs resulted in a significant cost saving (40.5%) and benefit in bed capacity (1.41 beds per day per year) for the hospital.
  
  
  CONCLUSIONS
  The implementation of a clinical pathway preserves the clinical outcome for patients undergoing OLC. It creates a significant increase in the number of patients treated in an outpatient setting and confers a significant benefit in terms of hospital costs and available bed capacity.
authors.affiliation: Department of Abdominal Surgery, University Hospital Gasthuisberg, Herestraat 49, Leuven, Belgium. baki.topal@med.kuleuven.be
authors.forename: B
authors.initials: B
authors.lastname: Topal
authors.forename: G
authors.initials: G
authors.lastname: Peeters
authors.forename: A
authors.initials: A
authors.lastname: Verbert
authors.forename: F
authors.initials: F
authors.lastname: Penninckx
mesh_terms: D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000191:economics*; D000704:Analysis of Variance; D001530:Belgium; D016009:Chi-Square Distribution; D017081:Cholecystectomy, Laparoscopic / Q000191:economics* / Q000379:methods; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D019091:Critical Pathways / Q000191:economics*; D005069:Evaluation Studies as Topic; D005260:Female; D006742:Hospital Bed Capacity / Q000706:statistics & numerical data*; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric