Researchers determined the success of a clinical pathway for outpatient laparoscopic cholecystectomy (LC) in an academic health center. They also assessed the impact of pathway implementation on same-day discharge rates, safety, patient satisfaction, and resource utilization, and reported their findings in May's Annals of Surgery.
During a 12-month period, 177 patients eligible for an elective laparoscopic cholecystectomy participated in a clinical pathway developed to transition laparoscopic cholecystectomy to an outpatient procedure.
208 patients undergoing elective laparoscopic cholecystectomy in the 15 months immediately before pathway implementation were used as a comparison.
|Proportion of same-day discharges:|
Before pathway implementation:
After pathway implementation:
|Annals of Surgery|
Successful same-day discharges, reasons for postoperative admission, readmission rates, complications, deaths, and patient satisfaction were compared between the groups. Average length of stay and total hospital costs were also calculated and compared.
The researchers found that after pathway implementation, the proportion of same-day discharges increased significantly, from 21% to 72%.
Unplanned postoperative admissions decreased as experience with the pathway increased.
Patient characteristics, need for readmission, complications, and deaths were found not to be different between the groups.
Patients surveyed were highly satisfied with their care. In addition, resource utilization declined, resulting in more available inpatient beds and substantial cost savings.
Dr J. Forrest Calland, of the Department of Surgery, University of Virginia Health System, said on behalf of the team, "Implementation of a clinical pathway for outpatient laparoscopic cholecystectomy was successful, safe, and satisfying for patients.
"Converting laparoscopic cholecystectomy to an outpatient procedure resulted in a significant reduction in medical resource use, including a decreased length of stay and total cost of care."