Clinical pathway for abbreviated postoperative hospital stay in free tissue transfer to the head and neck: Impact in resource utilization and surgical outcomes.
Academic Medical Centers
Aged
Analysis of Variance
Cohort Studies
Critical Pathways
Databases, Factual
Female
Free Tissue Flaps
/ blood supply
Graft Rejection
Graft Survival
Head and Neck Neoplasms
/ mortality
Health Resources
/ statistics & numerical data
Hospital Costs
Humans
Length of Stay
/ economics
Male
Middle Aged
Neck Dissection
/ methods
Postoperative Care
/ methods
Postoperative Complications
/ physiopathology
Prognosis
Quality of Life
Plastic Surgery Procedures
/ methods
Retrospective Studies
Treatment Outcome
United States
clinical pathways. (MeSH-NLM)
free flaps
head and neck reconstruction
microvascular
outcomes
progressive care unit
Journal
Head & neck
ISSN: 1097-0347
Titre abrégé: Head Neck
Pays: United States
ID NLM: 8902541
Informations de publication
Date de publication:
04 2019
04 2019
Historique:
received:
18
10
2017
revised:
12
09
2018
accepted:
01
10
2018
pubmed:
18
1
2019
medline:
10
10
2020
entrez:
18
1
2019
Statut:
ppublish
Résumé
Assess the impact of a clinical pathway and progressive care unit (CPW/PCU) for patients undergoing head and neck free flap reconstruction with regard to patient outcomes and resource utilization. Retrospective chart review of 270 patients at an academic tertiary-care center (2009-2014). Outcomes were compared among a control, CPW/PCU transition, and CPW/PCU groups. Compared to control, the CPW/PCU group had significantly reduced medical complications (21.1%-4.1%), intensive care unit length of stay (LOS, 5.02-0.2 days), hospital LOS (10.5-6.2 days), standardized total charges ($88 270-$58 661), and hospital costs ($41 365-$22 680). There were no observed differences in flap viability, surgical complications, reoperations, or readmissions. The CPW/PCU group achieved 100% home discharge. Our proposed CPW significantly improved patient outcomes and reduced resource utilization while maintaining flap outcomes. We propose a dynamic model for resource allocation that is easily reproducible in both academic and nonacademic settings.
Sections du résumé
BACKGROUND
Assess the impact of a clinical pathway and progressive care unit (CPW/PCU) for patients undergoing head and neck free flap reconstruction with regard to patient outcomes and resource utilization.
METHODS
Retrospective chart review of 270 patients at an academic tertiary-care center (2009-2014). Outcomes were compared among a control, CPW/PCU transition, and CPW/PCU groups.
RESULTS
Compared to control, the CPW/PCU group had significantly reduced medical complications (21.1%-4.1%), intensive care unit length of stay (LOS, 5.02-0.2 days), hospital LOS (10.5-6.2 days), standardized total charges ($88 270-$58 661), and hospital costs ($41 365-$22 680). There were no observed differences in flap viability, surgical complications, reoperations, or readmissions. The CPW/PCU group achieved 100% home discharge.
CONCLUSIONS
Our proposed CPW significantly improved patient outcomes and reduced resource utilization while maintaining flap outcomes. We propose a dynamic model for resource allocation that is easily reproducible in both academic and nonacademic settings.
Types de publication
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
982-992Informations de copyright
© 2019 Wiley Periodicals, Inc.