Objective The physical, service, and financial outcomes of noncomplex abdominal hysterectomy patients following a 23-hour pathway were compared with outcomes in similar patients who followed a 48-hour pathway and in those who underwent laparoscopically assisted vaginal hysterectomy in a series of 200 patients treated between February 1, 1997 and January 31, 1999. Methods Working from an already established 48-hour clinical pathway for abdominal and vaginal hysterectomy, a new 23-hour pathway was developed to allow selected patients to be treated as outpatients. The 23-hour pathway involved case management, home health care if needed, active pain management, and in most cases, spinal anesthesia. These patients underwent surgery and postoperative care in the hospital or in an ambulatory surgical center. Use of pain and nausea medicine, patient costs, and return-to-work time were measured. The outcomes of the noncomplex abdominal hysterectomy patients following the 23-hour pathway were compared with outcomes in similar patients who followed the 48-hour pathway and in those who underwent laparoscopically assisted vaginal hysterectomy. Results The 23-hour-pathway patients experienced significantly lower hospital costs compared with the 48-hour-pathway patients and the laparoscopically assisted vaginal hysterectomy patients. Pain and nausea control medications were also used less in the 23-hour patients. Recovery times for the 23-hour and laparoscopy patients were similar. Conclusion Clinical pathways have demonstrated the ability to efficiently render quality care and improve outcomes while producing cost savings. The 23-hour pathway for abdominal hysterectomy allows these goals to be achieved.
|Original language||English (US)|
|Number of pages||9|
|Journal||Journal of Pelvic Surgery|
|State||Published - 2001|
ASJC Scopus subject areas
- Obstetrics and Gynecology