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Implementation and evaluation of a clinical pathway for TRAM breast reconstruction
T G Hwang1, E G Wilkins, J C Lowery
1Section of Plastic Surgery at the University of Michigan, the Center for Practice Management and Outcomes Research at Ann Arbor VHA Health Services Research and Development Center of Excellence, 48109-0340, USA.
Implementing a clinical pathway for transverse rectus abdominis musculocutaneous (TRAM) breast reconstruction significantly reduced hospital stays and costs without increasing complications. This approach enhances cost-effectiveness in healthcare delivery.
Area of Science:
- Health Services Research
- Surgical Outcomes
- Health Economics
Background:
- Clinical pathways are increasingly used to standardize care, improve quality, and control costs in healthcare.
- Transverse rectus abdominis musculocutaneous (TRAM) breast reconstruction is a common procedure associated with significant costs.
- Evaluating the impact of clinical pathways on TRAM reconstruction outcomes is crucial for optimizing resource utilization.
Purpose of the Study:
- To assess the cost and quality outcomes of a clinical pathway program for transverse rectus abdominis musculocutaneous (TRAM) breast reconstruction.
- To determine if pathway implementation affects length of hospital stay, postoperative complications, and total costs.
Main Methods:
- A retrospective cohort study compared 29 patients treated under a TRAM reconstruction clinical pathway with 40 non-pathway control patients.
- Outcomes assessed included length of stay, postoperative complications, total charges, and relative value unit utilization.
- Analysis of covariance (ANCOVA) and F-tests were used to analyze differences and variances between groups, controlling for confounding variables.
Main Results:
- Implementation of the TRAM pathway led to a statistically significant decrease in length of hospital stay (6.0 to 5.2 days) and relative value unit utilization (1686 to 1104).
- Total postoperative charges decreased from $8587 to $7744.
- No significant increase in postoperative complications was observed, and variability in length of stay and resource utilization significantly decreased.
Conclusions:
- The TRAM reconstruction clinical pathway effectively reduced hospital length of stay and total costs.
- These resource utilization improvements did not negatively impact postoperative complication rates.
- Clinical pathways show promise for enhancing the cost-effectiveness of TRAM breast reconstruction and potentially other healthcare interventions.
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