Variance analysis of a clinical pathway of video-assisted single lobectomy for lung cancer.
OBJECTIVE
Clinical pathways have contributed to standardized postoperative management, but analyzing variance is also important to maintain quality control. To evaluate the validity of our own clinical pathway for managing video-assisted lobectomy for lung cancer, we analyzed the variances influencing postoperative recovery.


METHODS
Between April 2003 and April 2004, 62 consecutive patients with lung cancer underwent video-assisted single anatomic lobectomy with lymph node dissection. We evaluated 61 of these patients after the exclusion of one, who deviated from the clinical pathway management immediately as a result of serious complications.


RESULTS
There were 29 men and 32 women, with an average age of 65.7 years. Complications developed in 29 patients, but there was no operative mortality. The occurrence of variance ranged from 1.6% to 34.4% for each activity and included prolonged supplemental oxygen therapy, out-of routine examination, prolonged epidural anesthesia, and delayed bathing frequently. Complications and an abnormal body mass index were significant and independent clinical factors affecting the increase in variance.


CONCLUSIONS
Our original clinical pathway management was tolerable for lung cancer patients undergoing a video-assisted lobectomy. Complications and an abnormal body mass index were significant predictive factors for an increase in variance of our clinical pathway.
Okita
Atsushi
A
Department of Surgery, Unnan General Municipal Hospital, 96-1 Iida, Daitocho, Unnan, Shimane, 699-1221, Japan.
Yamashita
Motohiro
M
Abe
Keiko
K
Nagai
Chizuru
C
Matsumoto
Akiko
A
Akehi
Mika
M
Yamashita
Ryoko
R
Ishida
Naomi
N
Seike
Mikiko
M
Yokota
Shigeko
S
Umekawa
Nami
N
Matsumoto
Yumiko
Y
Kishimoto
Yoshiko
Y
Okazaki
Aiko
A
Komori
Eisaku
E
Sawada
Shigeki
S
Takashima
Shigemitsu
S
D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D016009:Chi-Square Distribution; D019091:Critical Pathways; D005260:Female; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000601:surgery*; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods; D011183:Postoperative Complications; D012307:Risk Factors; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D016896:Treatment Outcome