Impact of clinical pathways on hospital costs and early outcome after major vascular surgery. Discussion.
The purpose of this study was to determine whether major vascular surgery could be performed safely and with significant hospital cost savings by decreasing length of stay and implementation of vascular clinical pathways.
Morbidity, mortality, readmission rates, same-day admissions, length of stay, and hospital costs were compared between patients who were electively admitted between September 1,1992, and August 30,1993 (group 1), and January 1 to December 31,1994 (group 2), for extracranial, infrarenal abdominal aortic, and lower extremity arterial surgery.
For group 2 patients, vascular critical pathways were instituted, a dedicated vascular ward was established, and outpatient preoperative arteriography and anesthesiology-cardiology evaluations were performed.
Length-of-stay goals were 1 day for extracranial, 5 days for aortic, and 2 to 5 days for lower extremity surgery.
Emergency admissions, inpatients referred for vascular surgery, patients transferred from other hospitals, and patients who required prolonged preoperative treatment were excluded.
With this strategy same-day admissions were significantly increased (80% [145/177] vs 6.2% [9/145]) (p<0.0001), and average length of stay was significantly decreased (3.8 vs 8.8 days) (p<0.0001) in group 2 versus group 1, respectively.
There were no significant differences between group 1 and group 2 in terms of overall mortality rate (2.1% [3/145] vs 2.3% [4/177]), cardiac (3....
Mots-clés Pascal : Chirurgie, Aorte abdominale, Artère, Membre inférieur, Délai, Hospitalisation, Coût, Mortalité, Morbidité, Homme
Mots-clés Pascal anglais : Surgery, Abdominal aorta, Artery, Lower limb, Time lag, Hospitalization, Costs, Mortality, Morbidity, Human
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Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 96-0067847
Code Inist : 002B25F. Création : 199608.