Reduced Length of Stay By Implementation of a Clinical Pathway for Bariatric Surgery in an Academic Health Care Center

Huerta S, Heber D, Sawicki MP, Liu CD, Arthur D, Alexander P, Yip I, Li ZP, Livingston EH. The American Surgeon. 2001;67(12):1128-1135.

Objective

To present a detailed description of a bariatric surgery clinical pathway, including the use of Slim•Fast meal replacement shakes as part of the postoperative care process, and examine its effect on hospital cost, length of stay (LOS), and quality of care after implementation.

Methods

The medical charts of 364 patients who had undergone Roux-en-Y gastric bypass (RYGB) were analyzed regarding the following variables: hospital charges, LOS, outcomes, and readmissions rate. The bariatric surgery pathway, which delineates pre-, intra-, and post-operative care as well as patient outcomes, was implemented in July of 1999. To assess the efficacy of the pathway, the medical records of 182 patients were reviewed before implementation of the pathway (Group I). This information was compared with the data collected prospectively from 182 patients after implementation of the pathway (Group II). Data were analyzed with the SPSS statistical program. Differences in length of hospital stay, hospital cost, and morbidities and mortalities were assessed by the Student's t test and readmission rate was assessed by Chi-squared analysis.

Post operative management included dietary intervention divided into 6 progressive stages. Slim•Fast meal replacement shakes were recommended as tolerated at Stage III after discharge through 2 weeks post surgery. A 1200 calorie Slim•Fast meal replacement plan to replace 2 meals per day as part of the healthy eating for life regimen was the recommended Stage VI postoperative diet.

Results

Hospital cost per admission was reduced by 40% in Group II compared with Group I (p < 0.02). The average length of stay was reduced from 4.05 days in Group I to 3.17 days in Group II (p < 0.033). Overall readmission rate was decreased from 4.2% in Group I to 3.2% in Group II (p < 0.05). There were no differences in morbidities between the groups. The clinical pathway helped reduce costs by reducing the LOS, intensive care unit utilization and readmission rates. Quality was maintained as evidenced by a similar pattern of postoperative morbidities.

Conclusion

Implementation of a clinical pathway for bariatric surgery helps contain cost and improve quality of care in an academic institution.

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