Impact of clinical pathways in surgery.
BACKGROUND
One strategy to reduce the consumption of resources associated to specific procedures is to utilize clinical pathways, in which surgical care is standardized and preset by determination of perioperative in-hospital processes. The aim of this prospective study was to establish the impact of clinical pathways on costs, complication rates, and nursing activities.


METHODS
Data was prospectively collected for 171 consecutive patients undergoing laparoscopic cholecystectomy (n = 50), open herniorrhaphy (n = 56), and laparoscopic Roux-en-Y gastric bypass (n = 65).


RESULTS
Clinical pathways reduced the postoperative hospital stay by 28% from a mean of 6.1 to 4.4 days (p < 0.001), while the 30-day readmission rate remained unchanged (0.5% vs. 0.45%). Total mean costs per case were reduced by 25% from euro 6,390 to euro 4,800 (p < 0.001). Costs for diagnostic tests were reduced by 33% (p < 0.001). Nursing hours decreased, reducing nursing costs by 24% from euro 1,810 to euro 1,374 (p < 0.001). A trend was noted for lower postoperative complication rates in the clinical pathway group (7% vs. 14%, p = 0.07).


CONCLUSIONS
This study demonstrates clinically and economically relevant benefits for the utilization of clinical pathways with a reduction in use of all resource types, without any negative impact on the rate of complications or re-hospitalization.
Department of Surgery, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
Markus K
MK
Müller
Konstantin J
KJ
Dedes
Daniel
D
Dindo
Stefan
S
Steiner
Dieter
D
Hahnloser
Pierre-Alain
PA
Clavien
D000328:Adult; D017081:Cholecystectomy, Laparoscopic / Q000191:economics* / Q000451:nursing / Q000592:standards; D017046:Cost Savings / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D019091:Critical Pathways / Q000191:economics* / Q000592:standards; D003955:Diagnostic Tests, Routine / Q000191:economics; D005260:Female; D015390:Gastric Bypass / Q000191:economics* / Q000592:standards; D017048:Health Care Costs / Q000706:statistics & numerical data; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data; D006552:Hernia, Inguinal / Q000191:economics* / Q000451:nursing; D017721:Hospital Costs / Q000706:statistics & numerical data; D006784:Hospitals, Teaching / Q000191:economics; D006801:Humans; D010535:Laparoscopy / Q000191:economics* / Q000592:standards; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics; D009741:Nursing Staff, Hospital / Q000191:economics* / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000191:economics; D010865:Pilot Projects; D011183:Postoperative Complications / Q000191:economics* / Q000451:nursing / Q000517:prevention & control; D011446:Prospective Studies; D013557:Switzerland; D014600:Utilization Review / Q000706:statistics & numerical data