Evaluation of the clinical pathway for laparoscopic bariatric surgery.
BACKGROUND
Clinical pathways (CP) are comprehensive systematized patient care plans for specific procedures. The CP for morbid obesity was implemented in our department in September 2005. The aim of this study is to evaluate the clinical pathway for this procedure 1 year after implementation.


METHODS
A study was conducted on all the patients included in the CP since its implementation. The assessment criteria include degree of compliance, indicators of clinical care effectiveness, financial impact, and survey-based indicators of satisfaction. The results are compared to a series of patients undergoing surgery the year before the implementation of the CP. We analyzed the mean cost per procedure before and after CP implementation.


RESULTS
Evaluation was made of a series of 49 consecutive patients who underwent surgery over the period of 1 year before the development of the CP and met the accepted inclusion criteria. The mean length of hospital stay was 7.95 days, and the mean cost per procedure before pathway implementation was 5,270.37 (+/-2,251.19) euros. One year after the implementation of the pathway, 70 patients were included. The mean length of hospital stay of the patients included in the CP was 5.1 days. The degree of compliance with stays was 71.4%. The most frequent reason for noncompliance was patient-dependent causes. The mean cost in the series of patients included in the CP was 4,532 (+/-1,753) euros.


CONCLUSIONS
The CP for morbid obesity reduced both variability in professional care patterns and hospital costs; justifying the work involved in its development and implementation.
Campillo-Soto
Alvaro
A
Department of General Surgery, Hospital General Universitario J.M. Morales Meseguer, Calle Marqués de los Vélez s/n, 30008 Murcia, Spain. alvaroalcubo@yahoo.es
Martín-Lorenzo
Juan Gervasio
JG
Lirón-Ruíz
Ramón
R
Torralba-Martínez
José Antonio
JA
Bento-Gerard
Marina
M
Flores-Pastor
Benito
B
Aguayo-Albasini
José Luis
JL
D050110:Bariatric Surgery; D003362:Cost-Benefit Analysis; D019091:Critical Pathways / Q000458:organization & administration*; D019983:Guideline Adherence; D017721:Hospital Costs; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D009767:Obesity, Morbid / Q000601:surgery*; D010043:Outcome and Process Assessment, Health Care