Cawthorn Thomas R, Todd Anna R, Hardcastle Nina, Spencer Adam O, Harrop A Robertson, Fraulin Frankie O G
Section of Plastic Surgery, Department of Surgery, University of Calgary, Alberta, Canada.
Section of Pediatric Anesthesiology, Department of Anesthesiology, University of Calgary, Alberta, Canada.
Cleft Palate Craniofac J. 2022 May;59(5):561-567. doi: 10.1177/10556656211017409. Epub 2021 May 18.
To evaluate the development process and clinical impact of implementing a standardized perioperative clinical care pathway for cleft palate repair.
Medical records of patients undergoing primary cleft palate repair prior to pathway implementation were retrospectively reviewed as a historical control group (N = 40). The historical cohort was compared to a prospectively collected group of patients who were treated according to the pathway (N = 40).
Healthy, nonsyndromic infants undergoing primary cleft palate repair at a tertiary care pediatric hospital.
A novel, standardized pathway was created through an iterative process, combining literature review with expert opinion and discussions with institutional stakeholders. The pathway integrated multimodal analgesia throughout the perioperative course and included intraoperative bilateral maxillary nerve blocks. Perioperative protocols for preoperative fasting, case timing, antiemetics, intravenous fluid management, and postoperative diet advancement were standardized.
Primary outcomes include: (1) length of hospital stay, (2) cumulative opioid consumption, (3) oral intake postoperatively.
Patients treated according to the pathway had shorter mean length of stay (31 vs 57 hours, < .001), decreased cumulative morphine consumption (77 vs 727 μg/kg, < .001), shorter time to initiate oral intake (9.3 vs 22 hours, .01), and greater volume of oral intake in first 24 hours postoperatively (379 vs 171 mL, < .001). There were no differences in total anesthesia time, total surgical time, or complication rates between the control and treatment groups.
Implementation of a standardized perioperative clinical care pathway for primary cleft palate repair is safe, feasible, and associated with reduced length of stay, reduced opioid consumption, and improved oral intake postoperatively.
评估实施标准化腭裂修复围手术期临床护理路径的发展过程及临床影响。
将路径实施前接受初次腭裂修复患者的病历作为历史对照组进行回顾性分析（N = 40）。将该历史队列与根据该路径接受治疗的前瞻性收集患者组（N = 40）进行比较。
在一家三级儿科医院接受初次腭裂修复的健康、非综合征性婴儿。
通过反复过程创建了一种新颖的标准化路径，将文献综述与专家意见以及与机构利益相关者的讨论相结合。该路径在整个围手术期采用多模式镇痛，包括术中双侧上颌神经阻滞。术前禁食、病例时间安排、止吐药、静脉输液管理和术后饮食推进的围手术期方案均实现标准化。
主要结局包括：（1）住院时间；（2）阿片类药物累计消耗量；（3）术后经口摄入量。
根据该路径治疗的患者平均住院时间更短（31小时对57小时，P <.001），吗啡累计消耗量减少（77 μg/kg对727 μg/kg，P <.001），开始经口摄入的时间更短（9.3小时对22小时，P =.01），术后头24小时经口摄入量更大（379 mL对171 mL，P <.001）。对照组和治疗组之间的总麻醉时间、总手术时间或并发症发生率无差异。
实施标准化的初次腭裂修复围手术期临床护理路径是安全、可行的，且与缩短住院时间、减少阿片类药物消耗及改善术后经口摄入量相关。
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