Peripheral Vascular Surgery Society

#7 CAN THE COST OF DISTAL VASCULAR RECONSTRUCTION BE REDUCED WITHOUT SACRIFICING QUALITY? ANALYSIS OF 500 CASES.

Paul B. Kreienberg, MD, R. Clement Darling, III, MD, Benjamin B. Chang, MD, Sean P. Roddy, MD, Philip S.K. Paty, MD, William E. Lloyd, MD, and Dhiraj M. Shah, MD

Albany Medical College, Albany, NY.

Objective: The goal of clinical pathways is to reduce the cost of the hospitalization while maintaining acceptable results (patency, morbidity, and mortality). Patients who present with lower extremity revascularization pose a difficult problem, as these patients have significant comorbid medical disease. In this study, we analyze our results as well as the cost of treatment of patients undergoing lower extremity revascularization before and after the institution of clinical pathways.

Methods: Data was collected independently by the hospital financial office and surgical outcomes were derived from the prospectively collected computerized vascular registry. Data was analyzed for 12 months before and after institution of pathways. Cost, length of stay, use of ancillary services, as well as mortality, morbidity and patency were evaluated. During each period, patients were only selectively admitted to the intensive care unit based on perioperative risk factors independent of the pathway.

Materials: A non-disabling hemispheric stroke was defined as the persistence of symptoms of hemispheric ischemia for more than 24 hours, which resulted in no significant impairment in the activities of everyday life.

Results: Three hundred ninety-nine distal reconstructions were placed on the path during this time period. These were compared to a group of 286 who were not on the path in the year prior. During these time periods, the length of inpatient stay decreased from 14.3 days to 9.2 days. Electrolyte lab panels decreased from 12 draws per patient per admission to 2 draws per patient per admission. This trend was also seen in CBC (14 to 6), glucose (14 to 2.4), and creatinine 13.0 to 3.6). Perioperative mortality was 3.2% and 2.7% respectively in both time periods with no change in morbidity. Total cost for hospitalization decreased by 15% after instituting the clinical pathway.

Conclusion: From this data, we can demonstrate that the institution of clinical pathways not only decreased total cost, use of ancillary laboratory tests, and decreased length of stay, but also did not negatively impact on the outcome.

RETURN to Program

Last updated January 1,2000