-Report on Experiments and Clinical Cases-

Evaluation of the Clinical Pathway for Laparoscopic Cholecystectomy and Simulation of Short-term Hospitalization

Ken Yanagi^1,2, Koji Sasajima^1,2, Masayuki Miyamoto^1,2, Seiji Suzuki^1,2, Tadashi Yokoyama^1,2, Hiroshi Maruyama^1,2, Takeshi Matsutani^1,2, Yasuo Arima¹, Eiji Uchida¹ and Takashi Tajiri¹

¹Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School
²Department of Surgery, Nippon Medical School Tama Nagayama Hospital

The effectiveness of the clinical pathway for laparoscopic cholecystectomy was evaluated, and the efficiency of medical care was analyzed. The duration of hospitalization and the number of National Health Insurance (NHI) points for medical service fees were compared between 86 patients treated after introduction of the clinical pathway (pathway group) and 56 patients treated before introduction of the clinical pathway (pre-pathway group). In the pathway group, variance from the pathway occurred in 24 patients (27.9%) due to postponement of discharge in 7 patients, to earlier discharge in 5 patients, and to insertion of a bile duct catheter in 5 patients. Total and postoperative hospitalization times were significantly shorter in the pathway group than in the pre-pathway group (8.0 ± 1.6 vs 13.7 ± 9.0 days, p<0.0001, 5.4 ± 1.1 vs 6.5 ± 2.2 days, p<0.0001, respectively). In the pathway group, the total number of NHI points was lower and the number of points per day was higher. By simulation, the total number of NHI points for the 5-day pathway (discharge on postoperative day 3 or earlier) was significantly lower than that for the current 7-day pathway. Moreover, the weekly profit per bed with the 3-day pathway (discharge on postoperative day 1) was more than twice that with the current pathway. The results suggest that the clinical pathway for laparoscopic cholecystectomy is beneficial for patients and useful for the introduction of diagnosis procedure combination in our hospital.

J Nippon Med Sch 2007; 74: 409-413

Keywords
clinical pathway, laparoscopic cholecystectomy, short-term hospitalization, medical service fees, diagnosis procedure combination

Correspondence to
Ken Yanagi, Department of Surgery, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama, Tokyo 206-8512, Japan
naggy@nms.ac.jp

Received, June 29, 2007
Accepted, July 19, 2007