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

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 pre-pathway 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.