Impact of age on clinical care pathway length of stay after complex head and neck resection.
OBJECTIVE
This article investigates the effect of patient age on postoperative pathway length of stay (LOS) for head and neck surgery. Aggregate clinical results for 43 patients, enrolled in the CCP from June 1996-July 1997, are described. Patient age, comorbid status, and postoperative complications are analyzed with respect to impact on LOS.


METHODS
Tertiary level academic medical center with an operative otorhinolaryngology volume of approximately 1200 cases per year.


METHODS
Forty-three patients undergoing head and neck resection with primary closure, local flap, or free flap closure were enrolled on CCP from June 1996-July 1997. Length of stay, frequency of selected aggregated comorbidities, and frequencies of complications are analyzed with nonparametric statistics. A pre-pathway group of 87 consecutive patients is used for comparison.


METHODS
Length of stay and age.


RESULTS
Median actual LOS post-pathway for the patients enrolled in the first year of the pathway was 8 days. This met the CCP target and improved on pre-pathway LOS by 5 days (p <.001). The average LOS increased 25% from 8 days to 10 days for patients older than 65 years of age (p =.036, Mann-Whitney U test). Presence of a comorbidity and a complication concomitantly was statistically associated with increased LOS though not with advancing age (p =.003).


CONCLUSIONS
The CCP-reported performance improvement achieved by this pathway suggests improved resource use, and improved patient outcomes are achieved for postoperative care of head and neck surgery patients. Our experience suggests that advancing age creates a clinically significant increase in resource use represented by our finding of increasing LOS. This finding warrants further investigation.
University of Pennsylvania School of Nursing, 420 Guardian Drive, Philadelphia, Pennsylvania 19104-6096, USA. skagan@nursing.upenn.edu
Sarah H
SH
Kagan
Ara A
AA
Chalian
Andrew N
AN
Goldberg
Matthew L
ML
Rontal
Gregory S
GS
Weinstein
Barbara
B
Prior
Patricia F
PF
Wolf
Randal S
RS
Weber
D000046:Academic Medical Centers / Q000592:standards / Q000706:statistics & numerical data; D000328:Adult; D000367:Age Factors; D000368:Aged; D015897:Comorbidity; D019091:Critical Pathways; D005260:Female; D006258:Head and Neck Neoplasms / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010036:Otolaryngology / Q000592:standards*; D011183:Postoperative Complications / Q000453:epidemiology; D013503:Surgery Department, Hospital / Q000592:standards / Q000706:statistics & numerical data; D016896:Treatment Outcome