Effects of a clinical pathway of pulmonary lobectomy and bilobectomy on quality and cost of care.

PURPOSE: This study evaluates medical and economic effects of a clinical pathway (CP) for open lobectomy and bilobectomy with respect to process quality, outcome quality, and hospital cost.
METHODS: We compared 38 consecutive patients who underwent open lobectomy or bilobectomy between April 2007 and June 2008 and were treated with a CP (CP group) with 43 consecutive patients treated without CP between 2005 and 2007 (pre-pathway group). Indicators for process quality were duration of catheter placement, pain intensity, respiratory exercising, and mobilization. Outcome quality was measured through morbidity, mortality, re-operations, and re-admissions. Cost of hospital stay was calculated using an imputed daily rate.
RESULTS: Central venous catheters were used in 90% of patients in the CP group (pre-pathway group 40%; p < 0.0001). Epidural catheters were placed in 84% of patients in the CP group (pre-pathway group 56%; p = 0.01). Variation in duration of catheter placement was reduced in the CP group. The reduction of hospital stay was 3 days (-19%, p = 0.003). Perioperative outcome quality remained unchanged. There was a significant cost reduction of 1,614 euros per stay after CP introduction (-19%; p = 0.003).
CONCLUSIONS: After CP implementation for open lobectomy the quality and standardization of care improved. Although length of hospital stay was significantly reduced, there was no significant increase of re-admissions or morbidity. Patients benefited from a shortened hospital stay while the hospital achieved cost reduction. This early analysis shows that the implementation of CP for open lobectomy has positive effects in terms of quality and cost of care.