Outpatient Laparoscopic Cholecystectomy: Patient Outcomes After Implementation of a Clinical Pathway

Abstract

ObjectiveTo determine the success of a clinical pathway for outpatient laparoscopic cholecystectomy (LC) in an academic health center, and to assess the impact of pathway implementation on same-day discharge rates, safety, patient satisfaction, and resource utilization. Summary Background DataLaparoscopic cholecystectomy is reported to be safe for patients and acceptable as an outpatient procedure. Whether this experience can be translated to an academic health center or larger hospital is uncertain. Clinical pathways guide the care of specific patient populations with the goal of enhancing patient care while optimizing resource utilization. The effectiveness of these pathways in achieving their goals is not well studied. MethodsDuring a 12-month period beginning April 1, 1999, all patients eligible for an elective LC (n ϭ 177) participated in a clinical pathway developed to transition LC to an outpatient procedure. These were compared with all patients undergoing elective LC (n ϭ 208) in the 15 months immediately before pathway implementation. Successful same-day discharges, reasons for postoperative admission, readmission rates, complications, deaths, and patient satisfaction were compared. Average length of stay and total hospital costs were calculated and compared. ResultsAfter 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 not different between the groups. Patients surveyed were highly satisfied with their care. Resource utilization declined, resulting in more available inpatient beds and substantial cost savings.

Impact of clinical pathways in surgery

“…Most studies are focusing on one single operation and on length of hospital stay [6][7][8][9][10][11][12][13][14][15] ( Table 4). Costs were only analyzed with the help of general model calculations and resource utilization was not analyzed in detail [22][23][24]. All these studies found a reduction of hospital stay ranging between 14% and 46% as well as cost savings up to 47%.…”

Laparoscopic Cholecystectomy: An Initial Clinical Experience at Faridpur District

“…Laparoscopic cholecystectomy decreases postoperative pain, decreases the need for postoperative analgesia, shortens the hospital stay from 1 week to less than 24 hours, and returns the patient to full activity within 1 week compared with 1 month after open cholecystectomy [11][12] .…”

Implementation of a Critical Pathway for Patients with Acute Cholecystitis

“…3 Now, out-patient LC is increasing in the United States due to expensive admission costs. 6,8 However, some studies showed difficulty of LC on initial admission in patients with complicated gallstone diseases due to their severity of the disease. 4 Some institutions demonstrated that only 40% of patients with AC underwent cholecystectomy on initial admission, 9,10 despite the advantages of early cholecystectomy.…”

“…[2][3][4][5] Since laparoscopic procedure for cholecystectomy has been introduced, it has become the treatment of choice for symptomatic gallbladder stone. 6 The positive effects of implementing critical pathways has been assessed in laparoscopic cholecystectomy (LC) for chronic cholecystitis (CC). 5 However, only a few studies are present on the usefulness on critical pathway in acute cholecystitis (AC) are present, 4 because implementation of CP to AC is regarded as difficult due to wide variation of clinical manifestation.…”