Implementation of a Fast-Track Clinical Pathway Decreases Postoperative Length of Stay and Hospital Charges for Liver Resection

Abstract

A fast-track clinical pathway is designed to streamline patient care delivery and maximize cost effectiveness. It has decreased postoperative length of stay (LOS) and hospital charges for many surgical procedures. However, data on clinical pathways after liver surgery are sparse. This study examined whether use of a fast-track clinical pathway for patients undergoing elective liver resection affected postoperative LOS and hospital charges. A fast-track clinical pathway was developed and implemented by a multidisciplinary team for patients undergoing liver resection. Between July, 2007 and May, 2008, a total of 117 patients underwent elective liver resection: the fast-track clinical pathway (education of patients and families, earlier oral feeding, earlier discontinuation of intravenous fluid, no drains or nasogastric tubes, early ambulation, use of a urinary catheter for less than 24 h and planned discharge 6 days after surgery) was studied prospectively in 56 patients (postpathway group). These patients were compared with the remainder who had usual care (prepathway group). Outcome measures were postoperative LOS, perioperative hospital charges, intraoperative and postoperative complications, mortality, and readmission rate. Among all patients, 69 (59%) had complicating diseases and/or a history of surgery and 24 patients belonged to American Society of Anesthesiologists grade III–IV. Compared with the prepathway group, the postpathway group had a significantly shorter postoperative LOS (7 vs. 11 days, P < 0.01). The average perioperative hospital charges were RMB 26,626 for patients in the prepathway group and only RMB 21,004 for those in the postpathway group (P < 0.05), with no differences in intraoperative and postoperative complications (P = 0.814), mortality (P = 0.606), and readmission rate (P = 0.424). Implementation of the fast-track clinical pathway is an effective and safe method for reducing postoperative LOS and hospital charges for high-risk patients undergoing elective liver resection. The result supports the further development of fast-track clinical pathways for liver surgical procedures.

Impact of a Clinical Pathway on Hospital Costs, Length of Stay and Early Outcomes after Hepatectomy for Hepatocellular Carcinoma

“…In this study, both the postoperative hospital stay and total hospital stay after pathway implementation are found to be significantly shorter than those of the non-CP group. The mean LOHS for hepatectomy in our study is 8.3 days in the CP group, which is similar to that in a recent singlecentre study in China (Lin et al, 2011). Recently, it was evident that perioperative comprehensive supportive care interventions, including health education, psychological support and stress management, were associated with a shorter LOHS in patients with esophageal carcinoma (Zhang et al, 2013).…”

Outcomes after implementing the enhanced recovery after surgery protocol for patients undergoing tuberculous empyema operations

“…There are notable differences between the present study and the former report with regard to discharge exercises. For instance, Lin et al (13) reported that a postoperative length of stay of 6 days was ideal, and considered discharge before this time to be too early. It is difficult to confirm in a retrospective study if discharge was premature; however, it should be noted that the same discharge criteria were maintained throughout this study.…”

The physiotherapy management of patients undergoing abdominal surgery

“…Elements include minimal preoperative bowel preparation and fasting, admission on the day of surgery, aggressive early ambulation, strict analgesia protocols, early postoperative introduction of oral fluids and food, and minimal use of drips and drains. These pathways are safe, feasible and reduce complication rates and LOS across all types of abdominal surgery (Adamina et al 2011, Cerantola et al 2013, Coolsen et al 2013, Li et al 2012, Lin et al 2011, Varadhan et al 2010, Wijk et al 2014.…”