Pathways for Head and Neck Surgery: A Patient-Education Tool

BackgroundThe rising rates of primary caesarean section have resulted in a larger obstetric population with scarred uteri. Subsequent pregnancies in these women are risk-prone and may complicate. Besides ensuring standardised management, care pathways could be used to evaluate for perinatal outcomes in these high risk pregnancies. We aim to demonstrate the use of a care pathway for vaginal birth after caesarean section as a service evaluation tool to determine perinatal outcomes.MethodsA retrospective service evaluation by review of delivery case notes and records was undertaken at the Aga Khan University Hospital, Nairobi, Kenya between January 2008 and December 2009Women with ≥2 previous caesarean sections, previous classical caesarean section, multiple gestation, breech presentation, severe pre-eclampsia, transverse lie, placenta praevia, conditions requiring induction of labour and incomplete records were excluded. Outcome measures included the proportion of eligible women who opted for test of scar (ToS), success rate of vaginal birth after caesarean section (VBAC); proportion on women opting for elective repeat caesarean section (ERCS) and their perinatal outcomes.ResultsA total of 215 women with one previous caesarean section were followed up using a standard care pathway. The median parity (minimum-maximum) was 1.0[1-4]. The other demographic characteristics were comparable. Only 44.6% of eligible mothers opted to have a ToS. The success rate for VBAC was 49.4% with the commonest (31.8%) reason for failure being protracted active phase of labour. Maternal morbidity was comparable for the failed and successful VBAC group. The incidence of hemorrhage was 2.3% and 4.4% for the successful and failed VBAC groups respectively. The proportion of babies with acidotic arterial PH (< 7.10) was 3.1% and 22.2% among the successful and failed VBAC groups respectively. No perinatal mortality was reported.ConclusionsBesides ensuring standardised management, care pathways could be objective audit and service evaluation tools for determining perinatal outcomes.

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“…The median parity (minimum-maximum) was 1.0[1-4]. The other demographic characteristics were comparable.…”

Section: Resultsmentioning

confidence: 99%

“…A total of 215 women with one previous caesarean section were followed up using a standard care pathway. The median parity (minimum-maximum) was 1.0[ 1 - 4 ]. The other demographic characteristics were comparable.…”

Section: Resultsmentioning

confidence: 99%

The utility of clinical care pathways in determining perinatal outcomes for women with one previous caesarean section; a retrospective service evaluation

Wanyonyi

Karuga

2010

BMC Pregnancy Childbirth

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“…It has been shown that engagement strategies help patients feel empowered and have a sense of control over their recovery. 37 Our perioperative care pathway for microsurgical autologous breast reconstruction shows success in early and safe recovery. As a follow-up study, we are assessing the patient-reported outcomes regarding the quality of the patient’s recovery on the ERAS pathway.…”

Section: Discussionmentioning

confidence: 99%

An Enhanced Recovery after Surgery Pathway for Microvascular Breast Reconstruction Is Safe and Effective

Astanehe

Temple‐Oberle

Nielsen

et al. 2018

Plastic and Reconstructive Surgery - Global Open

120

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“…It is suggested that some patients are unable to take part in decision‐making regarding treatment options because of difficulties understanding the necessary information. Clarke (2002) claims that ‘surgical treatment for head and neck cancer includes a variety of complex operative procedures. Patients scheduled for these operations often are presented with overwhelming amounts of information.…”

Section: Decision‐makingmentioning

confidence: 99%

A literature review of head and neck cancer patients information needs, experiences and views regarding decision-making

Ziegler¹,

Newell²,

Stafford³

et al. 2004

Eur J Cancer Care

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This study reviews the body of existing research undertaken to explore head and neck cancer patients experiences of treatment for surgery, their information needs and their views regarding decision-making. Patients who suffer head and neck cancers and undergo surgery often report considerable psychological distress and impaired social functioning. To optimize survival, the decision about what treatment option to follow is often made quickly, with little support in terms of counsel or the provision of information. It is suggested that there is inadequate previous work exploring the content and delivery of information required by patients, their experiences and their views regarding decision-making to guide appropriate clinical interventions. By assimilating and critiquing existing work in this review an appropriate focus for further research is likely to be determined. An electronic search of relevant databases was undertaken including Cinahl, Medline, Psychinfo, Assia, the Cochrane Library and British Nursing Index. In addition, a grey literature search was also undertaken by hand. The search strategy was developed using recommendations from the Centre for Reviews and Dissemination 'Guidance for Those Carrying Out or Commissioning Reviews' (CRD Report Number 4, 2001). There is significant psychosocial and other functional disturbance amongst survivors of head and neck cancer surgery. Improved information giving may play a part in determining these outcomes.

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Pathways for Head and Neck Surgery: A Patient-Education Tool

Cited by 17 publications

References 6 publications

The utility of clinical care pathways in determining perinatal outcomes for women with one previous caesarean section; a retrospective service evaluation

The utility of clinical care pathways in determining perinatal outcomes for women with one previous caesarean section; a retrospective service evaluation

An Enhanced Recovery after Surgery Pathway for Microvascular Breast Reconstruction Is Safe and Effective

A literature review of head and neck cancer patients information needs, experiences and views regarding decision-making

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