Uchiyama K, Takifuji K, Tani M, Onishi H, Yamaue H
Second Department of Surgery, Wakayama Medical University, School of Medicine, 811-1 Kimiidera, Wakayama 641-8510, Japan.
Surg Endosc. 2002 Nov;16(11):1594-7. doi: 10.1007/s00464-002-9018-0. Epub 2002 Jun 27.
Although clinical pathways have become popular strategies to improve the quality of medication in the field of laparoscopic surgeries, their economical effectiveness is not well defined. The aim of this study was to investigate the effect of clinical pathways for laparoscopic surgeries on cost and length of hospital stay.
From January 2000 to June 2001, clinical pathways were introduced for laparoscopic surgeries, such as laparoscopic cholecystectomy (Lap. C, n = 210), laparoscopically assisted distal gastrectomy with Billroth-I reconstruction (Lap. B-I, n=33), and laparoscopically assisted colectomy (Lap. colon, n=34). We compared total lengths of hospital stay and the economical efficiency before and after pathway implementation at Wakayama Medical University Hospital.
The length of hospital stay in Lap. C was shortened from 7.8+/-2.6 (mean+/-SD) days to 6.9+/-2.0 days (p = 0.03) and the total costs during hospitalization decreased from yen 509,320+/-58,800 to yen 489,130+/-43,860 (p=0.009), resulting in less burden for patients. At the same time, the daily costs were increased from yen 66,230+/-8920 to yen 70,840+/-6820 (p=0.0001), indicating that more efficient medical care was being given to patients. Similar results were obtained in Lap. B-I and Lap. colon groups.
In our study, the implementation of clinical pathways in the field of laparoscopic surgeries produced significant decreases in length of total hospital stay and cost while maintaining the quality of patient outcomes.
尽管临床路径已成为提高腹腔镜手术领域用药质量的常用策略，但其经济有效性尚未明确界定。本研究旨在探讨腹腔镜手术临床路径对成本和住院时间的影响。
2000年1月至2001年6月，对腹腔镜手术引入临床路径，如腹腔镜胆囊切除术（Lap. C，n = 210）、腹腔镜辅助毕罗一世重建远端胃切除术（Lap. B-I，n = 33）和腹腔镜辅助结肠切除术（Lap. colon，n = 34）。我们比较了和歌山医科大学医院实施临床路径前后的总住院时间和经济效率。
Lap. C的住院时间从7.8±2.6（均值±标准差）天缩短至6.9±2.0天（p = 0.03），住院期间的总成本从509,320±58,800日元降至489,130±43,860日元（p = 0.009），减轻了患者的负担。同时，每日费用从66,230±8920日元增至70,840±6820日元（p = 0.0001），表明为患者提供了更高效的医疗服务。Lap. B-I组和Lap. colon组也获得了类似结果。
在我们的研究中，腹腔镜手术领域临床路径的实施显著缩短了总住院时间并降低了成本，同时保持了患者的治疗效果质量。
