Abstract
The objective of this study is to evaluate the cost-effectiveness of a postoperative clinical care pathway for patients undergoing major head and neck oncologic surgery with microvascular reconstruction. This is a comparative trial of a prospective treatment group managed on a postoperative clinical care pathway and a historical group managed prior to pathway implementation. Effectiveness outcomes evaluated were total hospital days, return to OR, readmission to ICU and rate of pulmonary complications. Costing perspective was from the government payer. 118 patients were included in the study. All outcomes demonstrated that the postoperative pathway group was both more effective and less costly, and is therefore a dominant clinical intervention. The overall mean pre- and post-pathway costs are $22,733 and $16,564 per patient, respectively. The incremental cost reduction associated with the postoperative pathway was $6,169 per patient. Implementing the postoperative clinical care pathway in patients undergoing head and neck oncologic surgery with reconstruction resulted in improved clinical outcomes and reduced costs.
References
Jan 1, 1992·The Laryngoscope·M K RaoD C Young
Jul 1, 1994·Journal of Nursing Care Quality·D Heacock, R A Brobst
Feb 1, 1993·European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology·B H TessM B Wagner
Aug 1, 1997·Head & Neck·T M McCullochE A Weymuller
Nov 11, 1999·Archives of Otolaryngology--head & Neck Surgery·E HannaJ Suen
Dec 2, 1999·Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery·J M HusbandsP F Wolf
Mar 18, 2000·Archives of Otolaryngology--head & Neck Surgery·A Y ChenH Goepfert
Mar 12, 2002·Archives of Otolaryngology--head & Neck Surgery·Kristin M GendronRandal S Weber
Sep 26, 2002·Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery·Gerry F FunkRussell B Smith
Aug 22, 2003·The New England Journal of Medicine·Steffie WoolhandlerDavid U Himmelstein
Nov 17, 2004·Archives of Otolaryngology--head & Neck Surgery·Kathleen LangMing-Ann Hsu
Mar 11, 2006·The Journal of Otolaryngology·James T BrookesJeffrey R Harris
Mar 11, 2006·The Journal of Otolaryngology·Ludwig E SmeeleJonathan C Irish
May 24, 2007·Plastic and Reconstructive Surgery·Neil F JonesBernard Markowitz
Aug 11, 2007·The Laryngoscope·Nicolas Y BuSaba, Debra A Schaumberg
Jun 19, 2009·Medical Care·Paul G Barnett
Aug 25, 2009·Head & Neck Oncology·Daniel NovakovicPatrick J Gullane
May 31, 2011·Journal of Medical Economics·Mayur M AmonkarApril Teitelbaum
Sep 3, 2011·European Journal of Anaesthesiology·Alain-S EichenbergerBernhard Walder
Mar 27, 2012·The Laryngoscope·Steven PetrarPeter MacDougall
Citations
Feb 6, 2016·Head & Neck·Hani Z MarzoukiHadi Seikaly
May 16, 2015·Behavioural Brain Research·Devin W McBrideJohn H Zhang
Nov 4, 2015·Journal of Otolaryngology - Head & Neck Surgery = Le Journal D'oto-rhino-laryngologie Et De Chirurgie Cervico-faciale·Daniel A O'ConnellHadi Seikaly
Oct 4, 2016·Journal of Cardiothoracic and Vascular Anesthesia·Lindsay E JubeltDavid L Reich
Jul 21, 2016·The Journal of Craniofacial Surgery·Yue YangGuoyong Yang
Nov 3, 2016·Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery·Peter S VoslerCarl H Snyderman
May 12, 2016·Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery·Andre IsaacHadi Seikaly
Feb 22, 2018·Plastic and Reconstructive Surgery. Global Open·Arezoo AstaneheChristiaan Schrag
Nov 15, 2017·Journal of Medical Systems·Hiroki FuruhataMitsuru Ikeda
Mar 29, 2018·International Journal of Integrated Care·Anum Irfan KhanVishal Kukreti
Dec 12, 2018·Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery·Brian SwendseidJoseph Curry
Jan 18, 2019·Head & Neck·Mauricio A Moreno, Juliana Bonilla-Velez
Jul 31, 2019·The Laryngoscope·William TierneyEric D Lamarre
Feb 13, 2018·Current Opinion in Otolaryngology & Head and Neck Surgery·Gerhard F Huber, Joseph C Dort
Jun 24, 2020·Journal of Otolaryngology - Head & Neck Surgery = Le Journal D'oto-rhino-laryngologie Et De Chirurgie Cervico-faciale·Joseph C DortT Wayne Matthews
Sep 19, 2015·Head & Neck·Jonathan F DautremontJoseph C Dort
Jun 24, 2020·Journal of Otolaryngology - Head & Neck Surgery = Le Journal D'oto-rhino-laryngologie Et De Chirurgie Cervico-faciale·Joseph C DortT Wayne Matthews
Sep 26, 2020·Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons·Earl Peter ParkAnthony B Morlandt
Dec 29, 2020·Oral Oncology·Kevin ChorathKarthik Rajasekaran
Dec 11, 2019·Journal of Cranio-maxillo-facial Surgery : Official Publication of the European Association for Cranio-Maxillo-Facial Surgery·Yue YangXiao-Feng Shan
Feb 17, 2021·American Journal of Otolaryngology·Clare RichardsonBrian D'Anza
Jul 3, 2021·Cancers·Rosie TwomeyKhara M Sauro