O'Connell Daniel A, Barber Brittany, Klein Max F, Soparlo Jeff, Al-Marzouki Hani, Harris Jeffrey R, Seikaly Hadi
Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada.
Faculty of Medicine and Dentistry, University of Alberta Hospital, 1E4.31 8440 112th Street NW, Edmonton, AB, T6R 2B7, Canada.
J Otolaryngol Head Neck Surg. 2015 Nov 2;44:45. doi: 10.1186/s40463-015-0090-6.
To determine if rigid adherence (where medically appropriate) to an algorithm/checklist-based patient care pathway can reduce the duration of hospitalization and complication rates in patients undergoing head and neck reconstruction with free tissue transfer.
Study design was a retrospective case-control study of patients undergoing major head and neck cancer resections and reconstruction at a tertiary referral centre. The intervention was rigid adherence to a pre-existing care pathway including flow algorithms and multidisciplinary checklists incorporated into patient charting and care orders. 157 patients were enrolled prospectively and were compared to 99 patients in a historical cohort. Patient charts were reviewed and information related to the patient, procedure, and post-operative course was extracted. The two groups were compared for number of major and minor complications (using the Clavien-Dindo system) and length of stay in hospital.
Comparing pre- and post-intervention groups, no significant difference was identified in duration of hospital stay (21.5 days vs. 20.5 days, p = 0.750), the rate of major complications was significantly higher in the pre-intervention cohort (25.3% vs. 14.0%, p = 0.031), the rate of minor complications was not significantly higher (34.3% vs 30.8%, p = 0.610).
Rigid adherence to our patient care pathway, and improved charting techniques including flow algorithms and multidisciplinary checklists has improved patient care by showing a significant reduction in the rate of major complications.
确定在医学上适当的情况下，严格遵循基于算法/检查表的患者护理路径是否可以缩短接受游离组织移植进行头颈部重建患者的住院时间并降低并发症发生率。
本研究设计为一项对在三级转诊中心接受头颈部癌症大手术切除及重建的患者进行的回顾性病例对照研究。干预措施是严格遵循预先存在的护理路径，包括纳入患者病历记录和护理医嘱中的流程算法和多学科检查表。前瞻性纳入了157例患者，并与历史队列中的99例患者进行比较。查阅患者病历，并提取与患者、手术及术后病程相关的信息。比较两组患者的严重及轻微并发症数量（采用Clavien-Dindo系统）和住院时间。
比较干预前后两组，住院时间无显著差异（21.5天对20.5天，p = 0.750），干预前队列的严重并发症发生率显著更高（25.3%对14.0%，p = 0.031），轻微并发症发生率无显著更高（34.3%对30.8%，p = 0.610）。
严格遵循我们的患者护理路径，以及改进包括流程算法和多学科检查表在内的病历记录技术，通过显著降低严重并发症发生率改善了患者护理。
