title: Cost-effectiveness analysis of a postoperative clinical care pathway in head and neck surgery with microvascular reconstruction.
abstract: BACKGROUND
  The objective of this study is to evaluate the cost-effectiveness of a postoperative clinical care pathway for patients undergoing major head and neck oncologic surgery with microvascular reconstruction.
  
  
  METHODS
  This is a comparative trial of a prospective treatment group managed on a postoperative clinical care pathway and a historical group managed prior to pathway implementation. Effectiveness outcomes evaluated were total hospital days, return to OR, readmission to ICU and rate of pulmonary complications. Costing perspective was from the government payer.
  
  
  RESULTS
  118 patients were included in the study. All outcomes demonstrated that the postoperative pathway group was both more effective and less costly, and is therefore a dominant clinical intervention. The overall mean pre- and post-pathway costs are $22,733 and $16,564 per patient, respectively. The incremental cost reduction associated with the postoperative pathway was $6,169 per patient.
  
  
  CONCLUSIONS
  Implementing the postoperative clinical care pathway in patients undergoing head and neck oncologic surgery with reconstruction resulted in improved clinical outcomes and reduced costs.
authors.forename: Jonathan F
authors.initials: JF
authors.lastname: Dautremont
authors.forename: Luke R
authors.initials: LR
authors.lastname: Rudmik
authors.forename: Justin
authors.initials: J
authors.lastname: Yeung
authors.forename: Tiffany
authors.initials: T
authors.lastname: Asante
authors.forename: Steve C
authors.initials: SC
authors.lastname: Nakoneshny
authors.forename: Monica
authors.initials: M
authors.lastname: Hoy
authors.forename: Amanda
authors.initials: A
authors.lastname: Lui
authors.forename: Shamir P
authors.initials: SP
authors.lastname: Chandarana
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Matthews
authors.forename: Christiaan
authors.initials: C
authors.lastname: Schrag
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada. jdort@ucalgary.ca.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Dort
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000191:economics / Q000601:surgery*; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D019091:Critical Pathways / Q000191:economics*; D005260:Female; D006258:Head and Neck Neoplasms / Q000191:economics / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D019651:Plastic Surgery Procedures; D000077195:Squamous Cell Carcinoma of Head and Neck