title: Variance analysis of a clinical pathway of video-assisted single lobectomy for lung cancer.
abstract: 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.
authors.affiliation: Department of Surgery, Unnan General Municipal Hospital, 96-1 Iida, Daitocho, Unnan, Shimane, 699-1221, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Okita
authors.forename: Motohiro
authors.initials: M
authors.lastname: Yamashita
authors.forename: Keiko
authors.initials: K
authors.lastname: Abe
authors.forename: Chizuru
authors.initials: C
authors.lastname: Nagai
authors.forename: Akiko
authors.initials: A
authors.lastname: Matsumoto
authors.forename: Mika
authors.initials: M
authors.lastname: Akehi
authors.forename: Ryoko
authors.initials: R
authors.lastname: Yamashita
authors.forename: Naomi
authors.initials: N
authors.lastname: Ishida
authors.forename: Mikiko
authors.initials: M
authors.lastname: Seike
authors.forename: Shigeko
authors.initials: S
authors.lastname: Yokota
authors.forename: Nami
authors.initials: N
authors.lastname: Umekawa
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Matsumoto
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Kishimoto
authors.forename: Aiko
authors.initials: A
authors.lastname: Okazaki
authors.forename: Eisaku
authors.initials: E
authors.lastname: Komori
authors.forename: Shigeki
authors.initials: S
authors.lastname: Sawada
authors.forename: Shigemitsu
authors.initials: S
authors.lastname: Takashima
mesh_terms: 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