Reduction of hospital stay and cost after the implementation of a clinical pathway for radical gastrectomy for gastric cancer

Abstract

Background. Clinical pathways have been used for various surgical procedures to improve outcomes and reduce costs. Radical gastrectomy is a major surgery for the treatment of gastric cancer. This study serves to evaluate the difference in clinical outcomes before and after patients were managed on a multidisciplinary gastrectomy pathway. Methods. Between 2000 and 2005, 115 consecutive patients who underwent gastrectomy were categorized into a prepathway group and a pathway group. This corresponded to the implementation of the clinical pathway in August 2002. The 61 patients in the pathway group were managed according to a multidisciplinary program, while the 54 patients in the pre-pathway group were managed conventionally. The clinical outcomes and hospital costs were then assessed and compared. Results. The two groups were similar in terms of demographics, comorbidities, types of gastrectomies, and pathological cancer staging. The postoperative length of hospital stay (LOS) was 9 days for the pathway group and 11 days for the pre-pathway group (P = 0.02), and the total LOS in the two groups was 11 and 14 days, respectively (P = 0.02). The cost of hospitalization for the pathway patients was S$13 338, which was significantly lower compared to the S$17 371 cost for the pre-pathway patients (P = 0.047). Conclusion. Clinical pathways may reduce hospital stay and costs for patients undergoing gastrectomy for the treatment of gastric cancer. © 2008 The International Gastric Cancer Association and The Japanese Gastric Cancer Association.