Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

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

  • Chung, Sang-Bong (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Sun-Ho (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Eun-Sang (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Eoh, Whan (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2012.02.03
  • Accepted : 2012.06.12
  • Published : 2012.06.28
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : The aim of this study is to implement a critical pathway (CP) for patients undergoing lumbar laminectomy or microdiscectomy and describe the results before and after the CP in terms of length of hospital stay and cost. Methods : From March 2008 to February 2009, 61 patients underwent lumbar laminectomy or microdiscectomy due to stenosis or one- or two-level disc herniation in our department and were included in the prepathway group. After development and implementation of the CP in March 2009, 58 patients were applicable for the CP, and these were classified as the postpathway group. Results : The CP, which established a 6-day hospital stay (5 bed-days), was fulfilled by 42 patients (72.4%) in the postpathway group. The mean length of stay was 5.4 days in the postpathway group compared to 6.9 days in the prepathway group, demonstrating a 20% reduction, which was a statistically significant difference ($p{\leq}0.000$). There was a statistically significant reduction in charges for bed and nursing care (p=0.002). Conclusion : Implementation of a CP for lumbar laminectomy or microdiscectomy produced significant decreases in length of hospitalization and charges for bed and nursing care. We believe that this CP reduces the unnecessary use of hospital resources without increasing risk of adverse events.

Keywords

References

  1. Atlas SJ, Tosteson TD, Blood EA, Skinner JS, Pransky GS, Weinstein JN : The impact of workers' compensation on outcomes of surgical and nonoperative therapy for patients with a lumbar disc herniation : SPORT. Spine (Phila Pa 1976) 35 : 89-97, 2010 https://doi.org/10.1097/BRS.0b013e3181c68047
  2. Coffey RJ, Richards JS, Remmert CS, LeRoy SS, Schoville RR, Baldwin PJ : An introduction to critical paths. Qual Manag Health Care 1 : 45-54, 1992 https://doi.org/10.1136/qshc.1.Suppl.45
  3. Cohen J, Stock M, Andersen P, Everts E : Critical pathways for head and neck surgery. Development and implementation. Arch Otolaryngol Head Neck Surg 123 : 11-14, 1997 https://doi.org/10.1001/archotol.1997.01900010013001
  4. Cohn LH, Rosborough D, Fernandez J : Reducing costs and length of stay and improving efficiency and quality of care in cardiac surgery. Ann Thorac Surg 64 : S58-S60; discussion S80-S82, 1997 https://doi.org/10.1016/S0003-4975(97)01158-2
  5. Gray DT, Deyo RA, Kreuter W, Mirza SK, Heagerty PJ, Comstock BA, et al. : Population-based trends in volumes and rates of ambulatory lumbar spine surgery. Spine (Phila Pa 1976) 31 : 1957-1963; discussion 1964, 2006 https://doi.org/10.1097/01.brs.0000229148.63418.c1
  6. Hart R, Musfeldt C : MD-directed critical pathways : it's time. Hospitals 66 : 56, 1992
  7. Isla-Guerrero A, Chamorro-Ramos L, Alvarez-Ruiz F, Aranda-Armengod B, Sarmiento-Martínez MA, Pérez-Alvarez M, et al. : [Design, implementation, and results of the clinical pathway for herniated lumbar disk.] Neurocirugia (Astur) 12 : 409-418, 2001 https://doi.org/10.1016/S1130-1473(01)70679-3
  8. Latini EE, Foote W : Obtaining consistent quality patient care for the trauma patient by using a critical pathway. Crit Care Nurs Q 15 : 51-55, 1992 https://doi.org/10.1097/00002727-199211000-00009
  9. Leibman BD, Dillioglugil O, Abbas F, Tanli S, Kattan MW, Scardino PT : Impact of a clinical pathway for radical retropubic prostatectomy. Urology 52 : 94-99, 1998 https://doi.org/10.1016/S0090-4295(98)00130-7
  10. Liao SL, Chu SH, Chen YT, Chung KP, Lai MK : The impact of a clinical pathway for transurethral resection of the prostate on costs and clinical outcomes. J Formos Med Assoc 97 : 345-350, 1998
  11. Mo J, Oh H, Ahn Y, Seo W : Implementation of a clinical pathway in primary spontaneous pneumothorax patients treated by wedge resection surgery. Clin Nurse Spec 24 : 295-303, 2010 https://doi.org/10.1097/NUR.0b013e3181f87235
  12. Muluk SC, Painter L, Sile S, Rhee RY, Makaroun MS, Steed DL, et al. : Utility of clinical pathway and prospective case management to achieve cost and hospital stay reduction for aortic aneurysm surgery at a tertiary care hospital. J Vasc Surg 25 : 84-93, 1997 https://doi.org/10.1016/S0741-5214(97)70324-0
  13. Musfeldt C, Hart RI : Physician-Directed Diagnostic and Therapeutic Plans : a quality cure for America's health-care crisis. J Soc Health Syst 4 : 80-88, 1993
  14. Nagata Y, Masuda A, Suzuki Y : Impact of a clinical pathway in cases of transurethral resection of the prostate. Tokai J Exp Clin Med 32 : 54-58, 2007
  15. Nicasio AM, Eagye KJ, Kuti EL, Nicolau DP, Kuti JL : Length of stay and hospital costs associated with a pharmacodynamic-based clinical pathway for empiric antibiotic choice for ventilator-associated pneumonia. Pharmacotherapy 30 : 453-462, 2010 https://doi.org/10.1592/phco.30.5.453
  16. Pritts TA, Nussbaum MS, Flesch LV, Fegelman EJ, Parikh AA, Fischer JE : Implementation of a clinical pathway decreases length of stay and cost for bowel resection. Ann Surg 230 : 728-733, 1999 https://doi.org/10.1097/00000658-199911000-00017
  17. Sheffield KM, Ramos KE, Djukom CD, Jimenez CJ, Mileski WJ, Kimbrough TD, et al. : Implementation of a critical pathway for complicated gallstone disease : translation of population-based data into clinical practice. J Am Coll Surg 212 : 835-843, 2011 https://doi.org/10.1016/j.jamcollsurg.2010.12.047
  18. Una E, Lopez-Lara F : Pilot study of a clinical pathway implementation in rectal cancer. Clin Med Insights Oncol 4 : 111-115, 2010

Cited by

  1. The impact of surgeon volume on patient outcome in spine surgery: a systematic review vol.27, pp.3, 2012, https://doi.org/10.1007/s00586-017-5447-2
  2. Percutaneous Endoscopic Lumbar Discectomy via Transforaminal Approach Combined with Interlaminar Approach for L4 /5 and L5 / S1 Two‐Level Disc Herni vol.13, pp.3, 2012, https://doi.org/10.1111/os.12862
  3. Integrated care pathways in neurosurgery: A systematic review vol.16, pp.8, 2012, https://doi.org/10.1371/journal.pone.0255628