Can the Cost of Distal Vascular Reconstruction be Reduced Without Sacrificing Quality? Analysis of 500 Cases

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, for they have significant comorbid medical disease. In this study the authors analyze their results and the treatment cost for patients undergoing lower extremity revascularization before and after the institution of clinical pathways. Data were collected independently by the hospital financial office, and surgical outcomes were derived from the prospectively collected computerized vascular registry. Data were analyzed for 12 months before and after institution of pathways. Cost, length of stay (LOS), and use of ancillary service as well as mortality, morbidity, and patency rates were evaluated. During each period, patients were selectively admitted to the intensive care unit based on perioperative risk factors independent of the pathway. Three hundred ninety-nine patients with distal reconstructions were placed on the path during this time period. These were compared to a group of 286 patients who were not on the path in the year prior. The LOS decreased from 14.3 days to 9.2 days. Electrolyte laboratory panels decreased from 12 draws per patient per admission to two draws per patient per admission. This trend was also seen in complete blood count (11.8 to 6.8), glucose (12.6 to 2.1), and electrolytes (12.2 to 1.8). Perioperative mortality rates were similar (2.5% vs 1.9%) with no change in morbidity rates. Total cost for hospitalization decreased by 27% after institution of the clinical pathway. From these data, the authors can demonstrate that the institution of clinical pathways not only decreased total cost, use of ancillary laboratory tests, and LOS but also did not negatively impact on outcome.