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Effects of a clinical pathway for video-assisted thoracoscopic surgery (VATS) on quality and cost of care

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Abstract

Purpose

The purpose of this study was to evaluate effects of a clinical pathway (CP) for video-assisted thoracoscopic surgery (VATS) on process quality, outcome quality, and hospital costs.

Materials and methods

We implemented a CP for VATS and compared 34 patients treated with CP to 77 patients treated without CP. Indicators for process quality were duration of catheter placement, pain intensity, respiratory exercising, and mobilization. Outcome quality was measured through morbidity, mortality, reoperations, and readmissions. Cost of hospital stay was calculated using an imputed daily rate.

Results

Foley catheters were removed significantly earlier after CP implementation. All patients on CP were mobilized and received pulmonary exercising on the operation day. Pain levels were low after CP implementation. Median hospital stay significantly reduced by 5 days. Perioperative outcome quality remained unchanged. Costs significantly diminished by 1,510 Euro per stay.

Conclusions

CP implementation had positive effects on process quality. Specifically, catheter management was improved and a good pain control achieved. Patients benefited from shortened stay and were treated at lower cost. A clear effect on outcome quality was not found. CPs are a promising tool for quality improvement and cost containment in thoracic surgery.

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References

  1. Donabedian A (1988) The quality of care. How can it be assessed? JAMA 260(12):1743–1748. doi:10.1001/jama.260.12.1743

    Article  CAS  PubMed  Google Scholar 

  2. Maessen JM, Dejong CH, Kessels AG et al (2008) Length of stay: an inappropriate readout of the success of enhanced recovery programs. World J Surg 32(6):971–975. doi:10.1007/s00268-007-9404-9

    Article  CAS  PubMed  Google Scholar 

  3. Goodney PP, Siewers AE, Stukel TA et al (2002) Is surgery getting safer? National trends in operative mortality. J Am Coll Surg 195(2):219–227. doi:10.1016/S1072-7515(02)01228-0

    Article  PubMed  Google Scholar 

  4. Canales MG, Macario A, Krummel T (2001) The surgical suite meets the new health economy. J Am Coll Surg 192(6):768–776. doi:10.1016/S1072-7515(01)00830-4

    Article  CAS  PubMed  Google Scholar 

  5. Ronellenfitsch U, Rössner E, Jakob J et al (2008) Clinical Pathways in surgery—should we introduce them into clinical routine? A review article. Langenbecks Arch Surg 393(4):449–457. doi:10.1007/s00423-008-0303-9

    Article  PubMed  Google Scholar 

  6. Zehr KJ, Dawson PB, Yang SC et al (1998) Standardized clinical care pathways for major thoracic cases reduce hospital costs. Ann Thorac Surg 66(3):914–919. doi:10.1016/S0003-4975(98)00662-6

    Article  CAS  PubMed  Google Scholar 

  7. Wright CD, Wain JC, Grillo HC et al (1997) Pulmonary lobectomy patient care pathway: a model to control cost and maintain quality. Ann Thorac Surg 64(2):299–302. doi:10.1016/S0003-4975(97)00548-1

    Article  CAS  PubMed  Google Scholar 

  8. Vigneswaran WT, Bhorade S, Wolfe M et al (2007) Clinical pathway after lung transplantation shortens hospital length of stay without affecting outcome. Int Surg 92(2):93–98

    PubMed  Google Scholar 

  9. Soria V, Coll A, Flores B et al (2005) Clinical pathway for the treatment of primary spontaneous pneumothorax in a general surgery department. Am J Med Qual 20(5):268–276. doi:10.1177/1062860605279710

    Article  PubMed  Google Scholar 

  10. Maruyama R, Miyake T, Kojo M et al (2006) Establishment of a clinical pathway as an effective tool to reduce hospitalization and charges after video-assisted thoracoscopic pulmonary resection. Jpn J Thorac Cardiovasc Surg 54(9):387–390. doi:10.1007/s11748-006-0014-5

    Article  PubMed  Google Scholar 

  11. Campbell H, Hotchkiss R, Bradshaw N et al (1998) Integrated care pathways. BMJ 316(7125):133–137

    CAS  PubMed  Google Scholar 

  12. McKenna RJ Jr, Mahtabifard A, Pickens A et al (2007) Fast-tracking after video-assisted thoracoscopic surgery lobectomy, segmentectomy, and pneumonectomy. Ann Thorac Surg 84(5):1663–1667. doi:10.1016/j.athoracsur.2007.05.058

    Article  PubMed  Google Scholar 

  13. Kehlet H (2008) Fast-track colorectal surgery. Lancet 371(9615):791–793. doi:10.1016/S0140-6736(08)60357-8

    Article  PubMed  Google Scholar 

  14. Curtis LT (2008) Prevention of hospital-acquired infections: review of non-pharmacological interventions. J Hosp Infect 69(3):204–219. doi:10.1016/j.jhin.2008.03.018

    Article  CAS  PubMed  Google Scholar 

  15. Gregor JI, Schwenk W, Mall J et al (2008) “Fast-track” rehabilitation in thoracic surgery. First experiences with a multimodal, interdisciplinary, and proven perioperative treatment course. Chirurg 79(7):657–664. doi:10.1007/s00104-008-1533-7

    Article  CAS  PubMed  Google Scholar 

  16. Stiller KR, Munday RM (1992) Chest physiotherapy for the surgical patient. Br J Surg 79(8):745–749. doi:10.1002/bjs.1800790807

    Article  CAS  PubMed  Google Scholar 

  17. Muehling BM, Halter GL, Schelzig H et al (2008) Reduction of postoperative pulmonary complications after lung surgery using a fast track clinical pathway. Eur J Cardiothorac Surg 34(1):174–180. doi:10.1016/j.ejcts.2008.04.009

    Article  PubMed  Google Scholar 

  18. Schwarz RE, Posner MC, Ferson PF et al (1998) Thoracoscopic techniques for the management of intrathoracic metastases. Results Surg Endosc 12(6):842–845. doi:10.1007/s004649900726

    Article  CAS  Google Scholar 

  19. Winter H, Meimarakis G, Pirker M et al (2008) Predictors of general complications after video-assisted thoracoscopic surgical procedures. Surg Endosc 22(3):640–645. doi:10.1007/s00464-007-9428-0

    Article  PubMed  Google Scholar 

  20. Tovar EA, Roethe RA, Weissig MD et al (1998) One-day admission for lung lobectomy: an incidental result of a clinical pathway. Ann Thorac Surg 65(3):803–806. doi:10.1016/S0003-4975(97)01381-7

    Article  CAS  PubMed  Google Scholar 

  21. Ueda K, Kaneda Y, Sakano H et al (2003) Obstacles for shortening hospitalization after video-assisted pulmonary resection for lung cancer. Ann Thorac Surg 76(6):1816–1820. doi:10.1016/S0003-4975(03)01079-8

    Article  PubMed  Google Scholar 

  22. Delaney CP, Zutshi M, Senagore AJ et al (2003) Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection. Dis Colon Rectum 46(7):851–859. doi:10.1007/s10350-004-6672-4

    Article  PubMed  Google Scholar 

  23. Avital S, Hermon H, Greenberg R et al (2006) Learning curve in laparoscopic colorectal surgery: our first 100 patients. Isr Med Assoc J 8(10):683–686

    PubMed  Google Scholar 

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Acknowledgments

We thank Bärbel Rothhaar for providing financial data and Brigitte Pagel for valuable support in teaching nursery staff and explaining the importance of process improvement.

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Correspondence to Matthias H. M. Schwarzbach.

Additional information

M. H. M. Schwarzbach and U. Ronellenfitsch contributed equally to the paper.

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Schwarzbach, M.H.M., Ronellenfitsch, U., Wang, Q. et al. Effects of a clinical pathway for video-assisted thoracoscopic surgery (VATS) on quality and cost of care. Langenbecks Arch Surg 395, 333–340 (2010). https://doi.org/10.1007/s00423-009-0507-7

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  • DOI: https://doi.org/10.1007/s00423-009-0507-7

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