Log in

Evaluation of the Clinical Pathway for Laparoscopic Bariatric Surgery

  • Research Article
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

Clinical pathways (CP) are comprehensive systematized patient care plans for specific procedures. The CP for morbid obesity was implemented in our department in September 2005. The aim of this study is to evaluate the clinical pathway for this procedure 1 year after implementation.

Methods

A study was conducted on all the patients included in the CP since its implementation. The assessment criteria include degree of compliance, indicators of clinical care effectiveness, financial impact, and survey-based indicators of satisfaction. The results are compared to a series of patients undergoing surgery the year before the implementation of the CP. We analyzed the mean cost per procedure before and after CP implementation.

Results

Evaluation was made of a series of 49 consecutive patients who underwent surgery over the period of 1 year before the development of the CP and met the accepted inclusion criteria. The mean length of hospital stay was 7.95 days, and the mean cost per procedure before pathway implementation was 5,270.37 (±2,251.19) euros. One year after the implementation of the pathway, 70 patients were included. The mean length of hospital stay of the patients included in the CP was 5.1 days. The degree of compliance with stays was 71.4%. The most frequent reason for noncompliance was patient-dependent causes. The mean cost in the series of patients included in the CP was 4,532 (±1,753) euros.

Conclusion

The CP for morbid obesity reduced both variability in professional care patterns and hospital costs; justifying the work involved in its development and implementation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Zander K. Critical pathways. In: Melum MM, Sinioris MK, editors. Total quality management. The health care pioneers. Chicago: AHA; 1992. p. 348–65.

    Google Scholar 

  2. DeZell AV, Comeau E, Zander K. Nursing case management: managed care via the nursing case management model. NLN Publ. 1987;(20-2191):253–64.

    Google Scholar 

  3. Lumsdon K, Hagland M. Map** care. Hosp Health Netw. 1993;20:34–40.

    Google Scholar 

  4. Courcoulas A, Perry Y, Buenaventura P, et al. Comparing the outcomes after laparoscopic versus open gastric bypass: a matched paired analysis. Obes Surg. 2003;13(3):341–6.

    Article  PubMed  Google Scholar 

  5. Patxon JH, Matthews JB. The cost effectiveness of laparoscopic versus open gastric bypass surgery. Obes Surg. 2005;15(1):24–34.

    Article  Google Scholar 

  6. Yeats M, Wedergren S, Fox N, et al. The use and modification of clinical pathways to achieve specific outcomes in bariatric surgery. Am Surg. 2005;71(2):152–4.

    PubMed  Google Scholar 

  7. Baker MT, Lara MD, Larson CD, et al. Length of stay and impact on readmission rates after laparoscopic gastric bypass. Surg Obes Relat Dis. 2006;2(4):435–9.

    Article  PubMed  Google Scholar 

  8. Huerta S, Heber D, Sawicki MP, et al. Reduced length of stay by implementation of clinical pathway for bariatric surgery in an academic health care center. Am Surg. 2001;67(12):1128–35.

    PubMed  CAS  Google Scholar 

  9. Carrasco G, Ferrer J. Las vías clínicas basadas en la evidencia como estrategia para la mejora de la calidad: metodología, ventajas y limitaciones. Rev Calid Asist. 2001;16:199–207.

    Google Scholar 

  10. Lázaro P, Fitch K. From universalism to selectivity: is appropriateness the answer? Health Policy. 1996;36:261–72.

    Article  PubMed  Google Scholar 

  11. Esteve N, Morales R, Casas I, et al. Controversias de las vías clínicas quirúrgicas. Todo Hosp. 2002;1:44–60.

    Google Scholar 

  12. Steinbrook RA, Freiberger D, Gosnell JL, et al. Prophilactic antiemetics for laparoscopic cholecystectomy: ondansetron versus droperidol plus metoclopramide. Anesth Analg. 1996;83:1081–3.

    Article  PubMed  CAS  Google Scholar 

  13. Otero R, Uresandi F, Cayuela A, et al. Use of venous thromboembolism prophylaxis for surgical patients: a multicentre analysis of practice in Spain. Eur J Surg. 2001;167(3):163–7.

    Article  PubMed  CAS  Google Scholar 

  14. González Linares RM. La estandarización de cuidados en la gestión del proceso asistencial. Rev Calid Asist. 1999;14:273–8.

    Google Scholar 

  15. Serrano Sastre R, Saracíbar Rázquin MI, Carrascal E, et al. Estandarizar los cuidados. Cuando lo hecho es valido. Rev Rol Enferm. 1997;227–228:23–31.

    Google Scholar 

  16. Madan AK, Speck KE, Ternovits CA, et al. Outcome of a clinical pathway for discharge within 48 hours after laparoscopic gastric bypass. Am J Surg. 2006;192(3):399–402.

    Article  PubMed  Google Scholar 

  17. Cooney RN, Haluck RS, Ku J, et al. Analysis of cost outliers after gastric bypass surgery: what can we learn? Obes Surg. 2003;13(1):29–36.

    Article  PubMed  Google Scholar 

  18. Ball C, Sackett D, Phillips B, et al. Techniques for locating evidence-based practice resources. Available at: http://cebm.jrw.ox.ac.uk/docs/levels.html.

  19. Cooney RN, Bryant P, Haluck R, et al. The impact of a clinical pathway for gastric bypass surgery on resource utilization. J Surg Res. 2001;98(2):97–101.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Álvaro Campillo-Soto.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Campillo-Soto, Á., Martín-Lorenzo, J.G., Lirón-Ruíz, R. et al. Evaluation of the Clinical Pathway for Laparoscopic Bariatric Surgery. OBES SURG 18, 395–400 (2008). https://doi.org/10.1007/s11695-007-9275-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-007-9275-z

Keywords

Navigation