Outpatient laparoscopic cholecystectomy: clinical pathway implementation is efficient and cost effective and increases hospital bed capacity.

BACKGROUND: Outpatient laparoscopic cholecystectomy (OLC) may decrease the use of hospital resources and save costs. In the current study, the effect of implementing a clinical pathway has been assessed in terms of outcome for patients scheduled to undergo laparoscopic cholecystectomy, hospital costs, and available bed capacity.

METHODS: Clinical outcome and hospital stay were analyzed for consecutive patients scheduled to undergo laparoscopic cholecystectomy 1 year before (n = 338) and after (n = 336) implementation of a clinical pathway. Patients with acute cholecystitis or bile duct lithiasis were excluded from the study. A cost accounting model was developed using the concept of the bill of activities.

RESULTS: Before implementation of the clinical pathway, 34 (94%) of 36 patients scheduled for OLC were discharged successfully on the day of surgery, as compared with 110 (94%) of 117 patients after pathway implementation. Among patients scheduled for OLC, the complication (0% vs 1.7%), unplanned admission (5.5% vs 6%), and readmission (0% vs 4.3%) rates were comparable before and after clinical pathway implementation. After pathway implementation, the increased number of OLCs resulted in a significant cost saving (40.5%) and benefit in bed capacity (1.41 beds per day per year) for the hospital.

CONCLUSION: The implementation of a clinical pathway preserves the clinical outcome for patients undergoing OLC. It creates a significant increase in the number of patients treated in an outpatient setting and confers a significant benefit in terms of hospital costs and available bed capacity.