IMPACT OF A CLINICAL PATHWAY FOR ELECTIVE INFRARENAL AORTIC RECONSTRUCTIONS

Objective To determine the impact of a clinical pathway for elective i nfrarenal aortic reconstruction on outcome, resource utilization, and cost in a university medical center. Summary Background Data Clinical pathways have been reported to control costs, reduce resource utilizat ion, and maintain or improve the quality of patient care, although the ir use during elective aortic reconstructions remains unresolved. Meth ods A clinical pathway was developed for elective infrarenal aortic re constructions by a multidisciplinary group comprised of representative s from each involved service. The prepathway practice and costs were a nalyzed and an efficient, cost-effective practice with specific outcom e measures was defined. The impact of the pathway was determined by re trospective comparison of outcome, resource utilization, and cost (tot al and direct variable) between the pathway patients (PATH, n = 45) an d a prepathway control group (PRE, n = 20). Results There were no sign ificant differences in the patient demographics, comorbid conditions, operative indications, or type of reconstruction between the groups. T here were no operative deaths and the overall complication rate (PRE, 35% vs. PATH, 34%) was similar. The pathway resulted in significant de creases in the total length of stay and preoperative length of stay an d a trend toward a significant decrease (p = 0.08) in the intensive ca re length of stay for the admission during which the operation was per formed. The pathway also resulted in significant decreases in both dir ect variable and total hospital costs for this admission, as well as a significant decrease in the overall direct variable and total hospita l costs for the operative admission and the preoperative evaluation (l ess than or equal to 30 days before operative admission). Despite thes e reductions, the discharge disposition, 30-day readmissions, and numb er of postoperative clinic visits within 90 days of discharge were not different. Conclusions Implementation of a clinical pathway for elect ive infrarenal aortic reconstructions dramatically decreased resource utilization and hospital costs without affecting the quality of patien t care and did not appear to shift the costs to another setting.