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The effects of a pediatric unilateral inguinal hernia clinical pathway on quality and cost
R E Kelly1, A Wenger, C Horton
1Department of Surgery, Eastern Virginia Medical School, Children's Hospital of The King's Daughters, Norfolk 23507, USA.
Insights
A pediatric inguinal hernia surgical clinical pathway (CP) significantly reduced costs by 10% for surgical repair. The CP did not affect wound infections, return visits, or surgical repair times, maintaining quality of care.
Area of Science:
- Pediatric Surgery
- Healthcare Management
- Clinical Pathways
Background:
- Pediatric inguinal hernias are common surgical conditions.
- Clinical pathways aim to standardize care and improve efficiency.
- Evaluating the impact of clinical pathways on surgical outcomes is crucial.
Purpose of the Study:
- To determine if a pediatric inguinal hernia surgical clinical pathway (CP) impacts wound infections, return visits, surgical repair times, or costs.
- To assess the cost-effectiveness of implementing a CP for pediatric inguinal hernia repair.
Main Methods:
- A multidisciplinary team developed a CP for pediatric inguinal hernia repair.
- A randomized intervention group (n=46) was compared to a matched retrospective control group (n=46).
- Statistical analyses (ANOVA, chi2) were used to compare outcomes including infections, return visits, repair times, and costs.
Main Results:
- No significant differences were observed in postoperative wound infections, surgical repair times, or 72-hour readmission rates between the groups.
- Total costs were significantly reduced by 10% for patients managed under the clinical pathway ($982 vs. $880).
Conclusions:
- The pediatric inguinal hernia surgical clinical pathway is associated with reduced healthcare costs.
- The implementation of this CP maintains the quality of care for pediatric patients undergoing inguinal hernia repair.
Background/Purpose:
The purpose of this study is to discover whether a pediatric inguinal hernia surgical clinical pathway (CP) reduces the frequency of wound infections, return visits, times associated with surgical repair, or costs.
Methods:
A multidisciplinary team developed the inguinal hernia surgical clinical pathway. Healthy children greater than 50 weeks gestational age who required unilateral hernia repair were considered for the study. Two groups were formed: (1) an intervention group selected randomly (n = 46, CI = 95%, power = .80) from patients enrolled from November 1996 through April 1997, and (2) a retrospective cohort control group (n = 46) matched to each intervention patient by age, gender, and medical history. Analysis of variance and chi2 testing were used to test for significant differences between the 2 groups in postoperative wound infections, readmission and emergency department return visits within 72 hours, times associated with surgical repair, and costs.
Results:
There were no significant differences in postoperative wound infections, times associated with surgical repair, or readmission rates within 72 hours. Total cost significantly decreased, by 10% (P< or = .05), for pathway patients ($982 v $880).
Conclusion:
These results show that the use of a pediatric inguinal hernia surgical clinical pathway is associated with reduced cost while maintaining quality of care.
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