Implementation and Outcomes of a Critical Pathway for Lumbar Laminectomy or Microdiscectomy

Chung, Sang-Bong; Lee, Sun-Ho; Kim, Eun-Sang; Eoh, Whan

doi:10.3340/jkns.2012.51.6.338

Cited by 8 publications

(5 citation statements)

References 15 publications

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“…Antibiotic use and complications in the CP group were significantly lower than those in the non-CP group in common bile duct stones patients undergoing retrograde cholangiopancreatography (ERCP) endoscopy (Zhang et al, 2019). The level of patient satisfaction was increased after the application of CP (Chung et al, 2012).…”

Section: Other Impactsmentioning

confidence: 93%

“…Overall studies consisting of 6 invasive treatments and 1 non-invasive treatment prove that there was a reduction in hospital days and total hospital costs after applying CP (Bartlett et al, 2017;Chung et al, 2012;Kagedan et al, 2017;Lin et al, 2011;Peng et al, 2018;Zhang et al, 2019;Zhu et al, 2014). Can be seen in Table 2.…”

Section: Impact On Length Of Stay and Costs After Applying Cpmentioning

confidence: 99%

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The Impact of Clinical Pathway Implementation on Length of Stay and Hospital Cost: A Systematic Review

Tanjung¹,

Nurwahyuni²

2019

Strengthening Hospital Competitiveness to Improve Patient Satisfaction and Better Health Outcomes

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Background: Clinical Pathway (CP) is a method of clinical documentation that reflects clinical practice standards for physicians, nurses, and other members of healthcare team. Clinical pathways are increasingly being used by hospitals to improve efficiency in the care of certain patient populations. This study aimed to review systematically the impact of CP implementation on length of stay and hospital cost. Subjects and Method: A systematic review was conducted by searching published articles from 2010 to 2019 from databases including: Proquest, Scopus, and Pubmed. The keywords for this review "impact, implementation, clinical pathways, critical pathways, care pathways, integrated care pathways, hospital costs and length of stay". The dependent variables were length of stay and hospital cost. The independent variable was CP. There were 7 articles obtained after implementing the inclusion criteria. Results: There was a significant reduction in hospital costs and length of stay after the implementation of CP. There was no significant difference between before and after the application of CP in aspects of complication, mortality, readmission, and clinical outcome. Conclusion: Implementation of CP can significantly reduce hospital length of stay and cost without reducing the quality of health service.

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Section: Other Impactsmentioning

confidence: 93%

Section: Impact On Length Of Stay and Costs After Applying Cpmentioning

confidence: 99%

The Impact of Clinical Pathway Implementation on Length of Stay and Hospital Cost: A Systematic Review

Tanjung¹,

Nurwahyuni²

2019

Strengthening Hospital Competitiveness to Improve Patient Satisfaction and Better Health Outcomes

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“…We included 13 cohort studies with a control group and 11 case series without a control group. All 13 cohort studies [23][24][25][26][27][28][29][30][31][32][33][34][35], attained a score of 9 out of 11 on the JBI checklist for cohort studies (see S3 Table ), whilst 10 of the 11 case series [36][37][38][39][40][41][42][43][44][45][46], attained a full score of 10 on the JBI checklist for case series, with one study scoring 8 (S4 Table ). We observed that the majority of the primary studies (18 of 24 (75%)) included were published from year 2010 onwards.…”

Section: Characteristics and Quality Of Included Studiesmentioning

confidence: 99%

“…Spine. Ten studies reported the function of ICP related to spinal surgeries for lumbar pathologies or adult scoliosis [23,29,32,34,40,[42][43][44][45][46]. Four involved a control group whereas six were case series.…”

Section: Plos Onementioning

confidence: 99%

Integrated care pathways in neurosurgery: A systematic review

et al. 2021

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Introduction Integrated care pathways (ICPs) are a pre-defined framework of evidence based, multidisciplinary practice for specific patients. They have the potential to enhance continuity of care, patient safety, patient satisfaction, efficiency gains, teamwork and staff education. In order to inform the development of neurosurgical ICPs in the future, we performed a systematic review to aggregate examples of neurosurgical ICP, to consider their impact and design features that may be associated with their success. Methods Electronic databases MEDLINE, EMBASE, and CENTRAL were searched for relevant literature published from date of inception to July 2020. Primary studies reporting details of neurosurgical ICPs, across all pathologies and age groups were eligible for inclusion. Patient outcomes in each case were also recorded. Results Twenty-four studies were included in our final dataset, from the United States, United Kingdom, Italy, China, Korea, France, Netherlands and Switzerland, and a number of sub-specialties. 3 for cerebrospinal fluid diversion, 1 functional, 2 neurovascular, 1 neuro-oncology, 2 paediatric, 2 skull base, 10 spine, 1 for trauma, 2 miscellaneous (other craniotomies). All were single centre studies with no regional or national examples. Thirteen were cohort studies while 11 were case series which lacked a control group. Effectiveness was typically evaluated using hospital or professional performance metrics, such as length of stay (n = 11, 45.8%) or adverse events (n = 17, 70.8%) including readmission, surgical complications and mortality. Patient reported outcomes, including satisfaction, were evaluated infrequently (n = 3, 12.5%). All studies reported a positive impact. No study reported how the design of the ICP was informed by published literature or other methods Conclusions ICPs have been successfully developed across numerous neurosurgical sub-specialities. However, there is often a lack of clarity over their design and weaknesses in their evaluation, including an underrepresentation of the patient’s perspective.

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“…Today, multiple‐level LDH is common due to changes in study and work habits. Normally, two‐level disc herniation can be treated by conventional lumbar laminectomy 11 . With the development of MISS and associated surgical instruments, two‐level disc herniation can also be resected through the transforaminal approach with just one portal skin incision 12 .…”

Section: Introductionmentioning

confidence: 99%

Percutaneous Endoscopic Lumbar Discectomy via Transforaminal Approach Combined with Interlaminar Approach for L4/5 and L5/S1 Two‐Level Disc Herniation

Zhou

Zhao

et al. 2021

Orthopaedic Surgery

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Objective The purpose of the present study was to discuss a new surgical strategy that combines percutaneous endoscopic transforaminal discectomy (PETD) with percutaneous endoscopic interlaminar discectomy (PEID) for L4/5 and L5/S1 two‐level disc herniation. Methods This was a retrospective study. A total of 19 patients with L4/5 and L5/S1 two‐level lumbar disc herniation (LDH) who underwent percutaneous endoscopic lumbar discectomy (PELD) in our hospital from January 2015 to June 2016 were retrospectively examined. The average age of these 19 patients was 42.21 ± 14.88 years old, including 12 men and 7 women. One experienced surgeon who had carried out more than 3000 lumbar surgeries performed PELD for these patients. During the PELD surgery, the transforaminal approach was adopted for L4/5 level disc herniation and the interlaminar approach was adopted for L5/S1 level disc herniation. The demographic data, operation time (min), fluoroscopy times, hospital stay (days), and complications were recorded and analyzed. The visual analogue scale (VAS), Oswestry disability index (ODI) scores, and the modified MacNab criteria were used to evaluate the surgical outcomes. MRI was conducted to evaluate the radiographic improvement. Results All patients underwent PELD via the transforaminal approach combined with the interlaminar approach successfully and achieved satisfactory efficacy. The follow‐up points were 3, 12, and 18 months. The average hospital stay (days) and the average follow up (months) were 3.32 ± 0.98 and 18.63 ± 3.84, respectively. The operation time and fluoroscopy times were 85.79 ± 12.90 min and 39.05 ± 4.59 times, respectively. The fluoroscopy times (frequency) for L4/5 and L5/S1 were 26.95 ± 6.41 and 12.11 ± 3.49 (t = 7.00, P < 0.05). Furthermore, there was no significant difference for fluoroscopy times between male and female patients (t = 0.89, P = 0.99). The preoperative back pain (VAS‐Back) and the last follow‐up VAS‐Back were 5.58 ± 2.01 and 2.37 ± 1.01, respectively (t = 7.14, P < 0.05). The preoperative leg pain (VAS‐Leg) and the last follow‐up VAS‐Leg were 7.00 ± 1.56 and 1.63 ± 1.01, respectively (t = 20.97, P < 0.05). There were significant differences between preoperative VAS‐Back and the last follow‐up VAS‐Back in men (t = 4.61, P < 0.05) and women (t = 6.57, P < 0.05). In addition, there was significant differences between preoperative VAS‐Leg and the last follow‐up VAS‐Leg in men (t = 13.48, P < 0.05) and women (t = 26.87, P < 0.05). There were significant differences between preoperative ODI scores (44.84 ± 10.82%) and the last follow‐up ODI scores (11.12 ± 5.80%) (t = 10.92, P < 0.05). Preoperative ODI scores and the last follow‐up ODI scores were significantly different for men (t = 8.80, P < 0.05) and women (t = 6.63, P < 0.05). All patients received significant pain relief and functional improvement after the surgery. Except for two cases of postoperative dysesthesia and one dural tear, no severe complications occurred. The dysesthesia symptoms of these two patients disappeared with...

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Implementation and Outcomes of a Critical Pathway for Lumbar Laminectomy or Microdiscectomy

Cited by 8 publications

References 15 publications

The Impact of Clinical Pathway Implementation on Length of Stay and Hospital Cost: A Systematic Review

The Impact of Clinical Pathway Implementation on Length of Stay and Hospital Cost: A Systematic Review

Integrated care pathways in neurosurgery: A systematic review

Percutaneous Endoscopic Lumbar Discectomy via Transforaminal Approach Combined with Interlaminar Approach for L4/5 and L5/S1 Two‐Level Disc Herniation

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