Impact of age on clinical care pathway length of stay after complex head and neck resection

Kagan, Sarah H.; Chalian, Ara A.; Goldberg, Andrew N.; Rontal, Matthew; Weinstein, Gregory S.; Prior, Barbara; Wolf, Pat; Weber, Randal S.

doi:10.1002/hed.10090

Cited by 24 publications

(21 citation statements)

References 14 publications

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“…The study selection flow diagram is summarized in Figure . Nine studies examined the implementation of a CCP using a before and after study design, however, only 1 study provided a temporal control . The remaining study used a cross‐sectional methodology .…”

Section: Resultsmentioning

confidence: 99%

“…To date, the extent to which CCPs succeed in achieving this potential for better outcomes and increased efficiency of care for patients undergoing head and neck cancer surgery remains uncertain, as few studies have been done to verify their impact. The purpose of this article was to systematically assess the benefits and pitfalls of CCPs through a review of their application for head and neck cancer surgery.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effectiveness of critical care pathways for head and neck cancer surgery: A systematic review

Gordon

Reiter

2016

Head & Neck

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effectiveness of critical care pathways for head and neck cancer surgery: A systematic review

Gordon

Reiter

2016

Head & Neck

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“…6 Although the influence of many clinical factors on LOS is both intuitive and supported by data, studies from medical and elective surgical patients confirm the additional importance of nonclinical factors. [7][8][9][10][11][12] One of these factors is insurance or payer status. We hypothesized that nonclinical factors, specifically payer status, would similarly affect LOS in injured patients.…”

mentioning

confidence: 99%

Length of Stay

et al. 2007

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Hypothesis: Although demographic and clinical information are known to affect hospital length of stay (LOS), we hypothesized that LOS after traumatic injury would be significantly influenced by nonclinical factors.Design: Retrospective database analysis.Patients: Trauma patients treated at hospitals participating in data submission to the National Trauma Data Bank.Methods: The National Trauma Data Bank was queried for all patients older than 18 years with an LOS longer than 48 hours and complete demographic information including age, sex, and race/ethnicity; nonclinical factors including payment type (commercial, Medicaid, Medicare, uninsured, and other) and discharge destination (home, rehabilitation facility, nursing home, and other); and clinical information (body region injured, Injury Severity Score, and Revised Trauma Score). Statistical analysis was performed using generalized linear modeling adjusted for multiple comparisons.Main Outcome Measures: Length of stay greater than the mean.Results: We obtained 313 144 medical records. Mean LOS was 9.6 days. Discharge destination had the greatest effect on LOS. Mean LOS for patients with Medicaid (11.3 days) was significantly longer than for patients with commercial insurance and uninsured patients (each 9.3 days) and patients with Medicare (8.8 days). Length of stay was longer for patients discharged to a nursing home (14.2 days) or rehabilitation facility (11.5 days) compared with those discharged to any other facility (9.6 days). In multivariate analysis, factors significantly associated with extended LOS included age, sex, race/ ethnicity, insurance status, discharge destination, and Revised Trauma Score.Conclusions: Nonclinical factors significantly influence LOS. If LOS is used as a quality measure for injured patients, adjustment for these factors is necessary.

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“…Other authors have reported on CPWs for head and neck cancer without microvascular free flap reconstruction and will not be reviewed here. [19][20][21]46,[48][49][50][51][52][53][54] To our knowledge, the most similar study to ours is by Dautremont et al, 22 who report on a CPW for patients undergoing head and neck microvascular reconstruction. In their study, patients were admitted to the ICU postoperatively, sedated, and on ventilatory support and were then transferred to the head and neck ward after extubation.…”

Section: Discussionmentioning

confidence: 53%

“…Comparing our results to this national benchmark, we observed that our control group outcomes were similar to these, yet after implementation of the pathway, our LOS was reduced to roughly half, with a lower rate of reoperation, no need for mechanical ventilation, and a 0% pneumonia rate. Other authors have reported on CPWs for head and neck cancer without microvascular free flap reconstruction and will not be reviewed here . To our knowledge, the most similar study to ours is by Dautremont et al, who report on a CPW for patients undergoing head and neck microvascular reconstruction.…”

Section: Discussionmentioning

confidence: 68%

Clinical pathway for abbreviated postoperative hospital stay in free tissue transfer to the head and neck: Impact in resource utilization and surgical outcomes

Moreno

Bonilla-Vélez

2019

Head & Neck

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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.

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Impact of age on clinical care pathway length of stay after complex head and neck resection

Cited by 24 publications

References 14 publications

Effectiveness of critical care pathways for head and neck cancer surgery: A systematic review

Effectiveness of critical care pathways for head and neck cancer surgery: A systematic review

Length of Stay

Clinical pathway for abbreviated postoperative hospital stay in free tissue transfer to the head and neck: Impact in resource utilization and surgical outcomes

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