Microvascular reconstruction and tracheotomy are significant determinants of resource utilization in head and neck surgery.
BACKGROUND
Successful "critical pathway" design and implementation are dependent on appropriate patient stratification according to those factors that are primary determinants of resource utilization.


OBJECTIVE
To test the validity of our previously reported critical pathway design and to determine whether tracheotomy and microvascular reconstruction (MR) are primary determinants of resource utilization.


METHODS
Cost-effectiveness analysis.


METHODS
Tertiary referral academic institution.


METHODS
Retrospective analysis of data from 133 head and neck surgery cases in which the treatment regimen was based on critical pathways over a 26-month period.


METHODS
Length of stay and total patient charges were used as indices of resource utilization. One-way analysis of variance and t tests were used for statistical analysis of significance.


RESULTS
Ninety patients (67.7%) underwent MR; 43 (32. 3%) did not. Seventy-five patients (56.4%) underwent tracheotomy; 58 (43.6%) did not. Four patient groups were constructed in decreasing order of complexity as follows: group 1, patients who underwent both tracheotomy and MR (n = 58); group 2, patients who underwent MR alone (n = 32); group 3, patients who underwent tracheotomy alone (n = 17); and group 4, patients who did not undergo either procedure (n = 26). Both tracheotomy and MR were found to be independent determinants of resource utilization and were additive when both were present. The length of stay varied from 8.4 days (in patients who underwent both procedures) to 6.7 days (in patients who did not undergo either procedure), with intermediate values in cases in which only 1 procedure was performed. The total charges varied in a similar manner from a high of $33,371 to a low of $19,994. Subanalysis with respect to intensive care unit, ward, and operating room charges showed a similar stratification.


CONCLUSIONS
Tracheotomy and MR are both significant determinants of charges and length of stay in head and neck surgery cases and must be considered in the design of strategies to promote efficient resource utilization.
Department Of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland 97201, USA. cohenj@ohsu.edu
J
J
Cohen
M
M
Stock
B
B
Chan
M
M
Meininger
M
M
Wax
P
P
Andersen
E
E
Everts
D003362:Cost-Benefit Analysis; D019091:Critical Pathways; D006295:Health Resources / Q000706:statistics & numerical data*; D006785:Hospitals, University / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007825:Laryngectomy / Q000191:economics* / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000191:economics; D008866:Microsurgery / Q000191:economics / Q000379:methods; D009922:Oregon; D012138:Respiratory Therapy / Q000191:economics / Q000706:statistics & numerical data; D014132:Trachea / Q000098:blood supply* / Q000601:surgery*; D014140:Tracheotomy / Q000191:economics* / Q000706:statistics & numerical data*