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01-04-2010 | Original article

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

Authors: Matthias H. M. Schwarzbach, Ulrich Ronellenfitsch, Qian Wang, Eric D. Rössner, Christof Denz, Stefan Post, Peter Hohenberger

Published in: Langenbeck's Archives of Surgery | Issue 4/2010

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

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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):93–98PubMed

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 CrossRefPubMed

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 CrossRefPubMed

11.

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

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 CrossRefPubMed

13.

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

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 CrossRefPubMed

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 CrossRefPubMed

16.

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

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 CrossRefPubMed

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 CrossRef

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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):683–686PubMed

Title: Effects of a clinical pathway for video-assisted thoracoscopic surgery (VATS) on quality and cost of care
Authors: Matthias H. M. Schwarzbach
Ulrich Ronellenfitsch
Qian Wang
Eric D. Rössner
Christof Denz
Stefan Post
Peter Hohenberger
Publication date: 01-04-2010
Publisher: Springer-Verlag
Published in: Langenbeck's Archives of Surgery / Issue 4/2010
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-009-0507-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Purpose

Materials and methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusions

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