The effects of a pediatric unilateral inguinal hernia clinical pathway on quality and cost

Background/Purpose: The purpose of this study is to discover whether a pedi atric inguinal hernia surgical clinical pathway (CP) reduces the frequency of wound infections, return visits, times associated with surgical repair, or costs. Methods: A multidisciplinary team developed the inguinal hernia surgical cl inical pathway. Healthy children greater than 50 weeks gestational age who required unilateral hernia repair were considered for the study. Two groups were formed: (1) an intervention group selected randomly (n = 46, Cl = 95% , power = .80) from patients enrolled from November 1996 through April 1997 , and (2) a retrospective cohort control group (n = 46) matched to each int ervention patient by age, gender, and medical history. Analysis of variance and chi(2) testing were used to test for significant differences between t he 2 groups in postoperative wound infections, read-mission and emergency d epartment return visits within 72 hours, times associated with surgical rep air, and costs. Results: There were no significant differences in postoperative wound infec tions, times associated with surgical repair, or readmission rates within 7 2 hours. Total cost significantly decreased, by 10% (P less than or equal t o .05), for pathway patients ($982 v $880). Conclusion: These results show that the use of a pediatric inguinal hernia surgical clinical pathway is associated with reduced cost while maintaining quality of care. Copyright (C) 2000 by W.B. Saunders Company.