title: Reduction of pulmonary complications and hospital length of stay with a clinical care pathway after head and neck reconstruction.
abstract: BACKGROUND
  Pulmonary complications are common after major head and neck oncologic surgery with microsurgical reconstruction and are associated with increased mortality and morbidity. Clinical care pathways are evidence-based tools that reduce unnecessary practice variation and ultimately improve patient outcomes. In this study, the authors evaluate the effectiveness of a comprehensive care pathway on reducing postoperative pulmonary complications and hospital length of stay in patients undergoing major head and neck carcinoma resection with free flap reconstruction.
  
  
  METHODS
  Fifty-five consecutive patients treated according to a prescribed postoperative clinical care pathway were compared to a historical cohort of patients treated before the implementation of the pathway. The incidence of pulmonary complications, hospital length of stay, and free flap survival were compared between the control and intervention groups.
  
  
  RESULTS
  Patients on the clinical care pathway had 32.5 percent fewer pulmonary complications (p < 0.0001) and 7.4 days' shorter hospital length of stay (p = 0.0007) than patients not on the postoperative pathway. There was no significant difference in the rate of flap reoperation.
  
  
  CONCLUSIONS
  A multidisciplinary, comprehensive, clinical care pathway for patients undergoing major head and neck surgery with microsurgical reconstruction is effective in reducing postoperative pulmonary complications and hospital length of stay. The postoperative pathway is safe in this patient population and should be considered for adoption into clinical practice.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Calgary, Alberta, Canada From the Sections of Plastic and Reconstructive Surgery and Otolaryngology-Head and Neck Surgery, Department of Surgery, Bachelor of Health Sciences Program and the Ohlson Research Initiative, Faculty of Medicine, and the Department of Medicine, University of Calgary.
authors.forename: Justin K
authors.initials: JK
authors.lastname: Yeung
authors.forename: Jonathan F
authors.initials: JF
authors.lastname: Dautremont
authors.forename: A Robertson
authors.initials: AR
authors.lastname: Harrop
authors.forename: Tiffany
authors.initials: T
authors.lastname: Asante
authors.forename: Naushad
authors.initials: N
authors.lastname: Hirani
authors.forename: Steve C
authors.initials: SC
authors.lastname: Nakoneshny
authors.forename: Vim
authors.initials: V
authors.lastname: de Haas
authors.forename: David
authors.initials: D
authors.lastname: Mckenzie
authors.forename: T Wayne
authors.initials: TW
authors.lastname: Matthews
authors.forename: Shamir P
authors.initials: SP
authors.lastname: Chandarana
authors.forename: Christiaan
authors.initials: C
authors.lastname: Schrag
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Dort
mesh_terms: D000368:Aged; D019091:Critical Pathways; D005260:Female; D058752:Free Tissue Flaps; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008171:Lung Diseases / Q000517:prevention & control*; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D019651:Plastic Surgery Procedures