Clinical Pathway for the Treatment of Primary Spontaneous Pneumothorax in a General Surgery Department

Abstract

Primary spontaneous pneumothorax is a common abnormality for which there is a variety of treatments. This study presents the results of a year's evaluation of a clinical pathway (CP). A series of 34 patients treated during 1 year before CP development was analyzed to identify the weak points. To address these weak points, the CP includes associated protocols. In the CP, 31 patients were evaluated during 1 year; the results were compared with those of the pre-CP series. The mean length of stay of the pre-CP patients and the CP patients was 7.3 days and 5.0 days, respectively. The number of radiographs fell from 4.3 to 3.2. The rate of complications and readmissions is similar in both groups. The mean cost per process dropped from 1863 [UNKNOWN] to 1168 [UNKNOWN]. The CP for pneumothorax successfully manages to reduce both the variability in care patterns and hospital costs, justifying the work involved in its development and implementation.

Effects of a clinical pathway for video-assisted thoracoscopic surgery (VATS) on quality and cost of care

“…We found a significant decrease of hospital costs as a direct consequence of shortened length of stay. The magnitude of saved costs is roughly in line with that reported in other studies [6,7,9,10]. Relative stay reduction and cost saving depended on the type of VATS.…”

“…This underpins that CPs with enhanced recovery schemes do not lead to hastened discharge of unfit patients if sound perioperative standards are established and adhered to. As in the other available comparative studies [6,7,9,10], CP introduction led to a significant shortening of hospital stay. In our case, the reduction was particularly pronounced, probably due to the meticulous integration of an enhanced recovery (fast track) scheme into the CP.…”

“…We were able to measure several features of perioperative care, which had not been evaluated before when looking at CP usage in thoracic surgery [6][7][8][9][10]. Specifically, our study is the first to demonstrate that CPs are able to thoroughly standardize invasive catheter management.…”

“…Moreover, data are sparse and stem mostly from the USA and Japan. The single available European study reports exclusively on pneumothorax treatment with chest drainage and no surgery [9]. Since CP effects must be assumed to be strongly setting-specific [11], there is a definite need for more ample evidence from Europe covering all aspects of CP usage, including effects on process quality measured through treatment parameters.…”

“…Lobectomy, video-assisted thoracoscopic surgery (VATS), pneumothorax treatment, and lung transplantation have been studied [6][7][8][9][10]. However, of these studies, one has no comparison group [8], and three do not assess process quality with clinical treatment parameters such as time of drainage removal [6][7][8].…”