Laryngectomy clinical pathway: development and review.
OBJECTIVE
The goal of the study is to determine if the implementation of a protocol for the preoperative and postoperative care of patients receiving a laryngectomy for cancer of the larynx or hypopharynx (i.e., laryngectomy clinical pathway) reduced length and cost of hospital stay without increasing complication rates.


METHODS
This study is a comparison of the perioperative course of two groups of laryngectomy patients. Data were collected retrospectively from the records of patients operated on before the implementation of the clinical pathway as the institutional historical control. Comparison was made with data collected prospectively on patients operated on after the implementation of the clinical pathway.


METHODS
The study was performed at a mid-sized teaching hospital associated with two regional cancer centres. All surgeries were performed by one of two otolaryngology-head and neck surgeons and residents under their supervision.


METHODS
The demographic, patient, tumour, treatment, dietary, and complication data were analyzed. Fisher's exact (two-tailed) statistical test was used for parametric data and Wilcoxon scores for nonparametric data.


METHODS
The principal outcome measure was the length of postoperative inpatient stay. Secondary outcome measures were readmissions and postoperative complications.


RESULTS
There was a statistically significant decrease of 6.7 days in the mean length of hospitalization in the clinical pathway group even when taking postoperative readmissions into account. There was no concomitant increase in surgical complications. The mean reduction in hospital cost per case was calculated to be $3,420 (Can).


CONCLUSIONS
Application of a clinical pathway for patients receiving laryngectomy is both feasible and effective.
Sherman
D
D
Department of Otolaryngology, University of Western Ontario, St Joseph's Health Centre, London, Ontario.
Matthews
T W
TW
Lampe
H
H
LeBlanc
S
S
D016022:Case-Control Studies; D019091:Critical Pathways; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000601:surgery; D007822:Laryngeal Neoplasms / Q000601:surgery; D007825:Laryngectomy; D007902:Length of Stay / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology; D011300:Preoperative Care