Advantages of clinical pathways in severity-based treatment of spondylodiscitis

Clinical pathways as tool to organize surgical, interventional, or conservative therapies are more and more accepted in the German health care system. Does an IT-based clinical pathway offer advantages in the severity-based surgical therapy of spondylodiscitis? Based on three severity grades of spondylodiscitis, an IT-based working tool has been included in the hospital IT system. From January 1, 2012, to December 31, 2013, 32 patients with spondylodiscitis were randomized and prospectively analyzed regarding duration and costs of treatment, pain level, and inflammatory markers. Of the 32 patients treated for spondylodiscitis, who had not been transferred from another facility, 17 (53%) were treated according to a clinical pathway on the basis of three well-established treatment regimens depending on severity. The SponDT, as a parameter for the course of disease, was initially slightly higher in the pathway patient’s group (6.82) than in the control group (6.2). Compared to the control group (n = 15), there were differences in the total duration of stay (17.2 vs. 26.0) and the number of taken blood samples (7 vs.10). No differences could be shown for the extent of documentation, the physical and neurological outcome, the level of pain and the course of inflammatory markers. The most prevalent germ was Staphylococcus aureus (18.8%). In 43.8%, no infectious agent could be detected. Material costs and personnel costs were significantly reduced in the pathway group (12.076 €) compared to 21.341 € in the control group. An IT-based clinical pathway is routinely applicable for the surgical therapy of spondylodiscitis based on three grades of severity and offers various advantages as a clinical and administrative regulative mechanism. Particularly, cost-effective treatment stands out.