微血管颌面重建手术综合临床护理路径
A Comprehensive Clinical Care Pathway for Microvascular Maxillofacial Reconstructive Surgery.
作者信息
Abo Sharkh Haider, Madathil Sreenath, Al-Ghamdi Osama, Agnihotram Ramanakumar V, Sinha Avinash, El-Hakim Michel, Nicolau Belinda, Makhoul Nicholas
机构信息
Fellow in Maxillofacial Oncology and Microvascular Reconstruction, Department of Oral and Maxillofacial Surgery, McGill University Health Center, Montreal, Quebec, Canada.
Research Director, Department of Oral and Maxillofacial Surgery, McGill University Health Center, Montreal, Quebec, Canada.
出版信息
J Oral Maxillofac Surg. 2019 Nov;77(11):2347-2354. doi: 10.1016/j.joms.2019.04.027. Epub 2019 May 7.
PURPOSE
Clinical care pathways (CCPs) for major surgical procedures are less developed. We describe the development of a comprehensive microvascular maxillofacial reconstruction CCP and evaluate the impact.
MATERIALS AND METHODS
Our team developed a comprehensive CCP for patients undergoing microvascular free flap reconstruction for benign or malignant tumors. Patient data before (n = 48) and after (n = 47) implementation of the CCP were used to evaluate the impact. Bayesian negative binomial and logistic regression analyses were used to estimate the associations between the CCP and clinical outcomes (length of stay [LOS], readmission to the operating room, and readmission within 3 months of discharge).
RESULTS
The average total hospital LOS was high in the pre-CCP group (16.9 days) compared with the post-CCP group (9.8 days). Being in the post-CCP group reduced the LOS in the intensive care unit and surgical ward and reduced the risk of readmission to the operating room.
CONCLUSION
Our results underscore the importance of standardized evidence-based patient care through CCPs for complex patient populations.
目的
主要外科手术的临床护理路径（CCP）发展尚不完善。我们描述了一种全面的微血管颌面重建CCP的开发过程，并评估其影响。
材料与方法
我们的团队为接受良性或恶性肿瘤微血管游离皮瓣重建的患者制定了全面的CCP。使用实施CCP之前（n = 48）和之后（n = 47）的患者数据来评估其影响。采用贝叶斯负二项式和逻辑回归分析来估计CCP与临床结局（住院时间[LOS]、再次进入手术室以及出院后3个月内再次入院）之间的关联。
结果
与CCP实施后组（9.8天）相比，CCP实施前组的平均总住院LOS较高（16.9天）。处于CCP实施后组可缩短重症监护病房和外科病房的住院时间，并降低再次进入手术室的风险。
结论
我们的结果强调了通过CCP为复杂患者群体提供标准化循证患者护理的重要性。
Zotero 插件