Background. Patient care pathways have been developed for operative procedures with documented improvements in length of stay and cost without compromising outcome. The average hospital stay after colonic resection is 5 to 10 days. This study describes a clinical pathway,for colon resections and examines patient outcome before and after institution of the pathway. Methods. One hundred thirty-eight patients underwent elective colon resections at our institution by a single surgeon before (n = 52) and after (n = 86) introduction of a clinical pathway. Length of stay, postoperative complications, readmissions, and cost per patient were compared between the 2 groups. Results. Mean total length of stay ( standard deviation [SD]) was less in the postclinical pathway patients (3.7 +/- 1.5 days) compared to preclinical pathway patients (6.6 +/- 3.3 days) (P <. 001). Men adjusted for age, sex, diagnosis, and type of operation, the difference in length of stay remains statistically significant (P < .001). There was 1 readmission in the prepathway group and 8 readmissions in the postpathway group. Men the readmissions were added to the original admissions, the mean length of stay in the postpathway patients was 4.2 +/- 2.8 days and in the prepathway patients was 6.9 +/- 4.1 days (P <. 001). The average cost per patient ( standard error of the mean), with readmission costs added, was $9310 +/- $5170 in the prepathway group and $7070 +/- $3670 in the postpathway group (P = .002). Conclusions. The institution of a clinical pathway for elective, open colon resections can be done safely with improvements in cost and length of stay.
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