Abstract
Background: Complications following total laryngectomy can lead to increased hospital length of stay (LOS) and increased health care costs. Our objective was to determine the efficacy of a clinical care pathway for improving outcomes for patients following total laryngectomy.Methods: This quality improvement study included all adult patients undergoing total laryngectomy—either primary or salvage—at a tertiary referral center between January 2013 and December 2018. The primary outcome was hospital LOS measured in postoperative days. The total and specific postoperative complication frequencies were evaluated, as well as 30-day readmission rates and intensive care unit (ICU) LOS.Results: Sixty-three patients were included in the study: 29 (46.0%) patients before the pathway implementation and 34 (54.0%) patients after pathway implementation. Demographic characteristics between the groups were similar. The prepathway cohort had a higher rate of total complications compared to the postpathway group (relative risk=0.5; 95% CI 0.3-1.0), although the differences in individual complications were similar. The median LOS of 10 days was the same for the 2 cohorts. The median ICU LOS was 1 day greater in the postpathway cohort, but no difference was seen in rates of ICU readmission in the 2 groups. The 30-day readmission rate also was not significant between the 2 groups.Conclusion: Implementation of a postoperative order set pathway for patients undergoing laryngectomy is associated with decreased overall complication rates. Use of a clinical care pathway may improve outcomes in patients undergoing total laryngectomy.
Highlights
More than 12,000 cases of laryngeal cancer are diagnosed in the United States annually, leading to almost 3,800 deaths.[1]
Inclusion criteria were based on current procedural terminology (CPT) codes corresponding to total laryngectomy without radical neck dissection (CPT 31360) and total laryngectomy with radical neck dissection (CPT 31365)
We found a reduction in the rate of total complications among the postpathway cohort compared with the prepathway group (RR=0.5; 95% CI 0.3-1.0), the differences in individual complications were similar
Summary
More than 12,000 cases of laryngeal cancer are diagnosed in the United States annually, leading to almost 3,800 deaths.[1]. The goal of the pathway is to standardize interventions and improve delivery of care Clinical pathways such as the one used at our institution have been implemented elsewhere for a variety of conditions and have been shown to improve patient outcomes while reducing complications, costs, and length of stay (LOS).[8,9,10,11,12]. The total and specific postoperative complication frequencies were evaluated, as well as 30-day readmission rates and intensive care unit (ICU) LOS. The median ICU LOS was 1 day greater in the postpathway cohort, but no difference was seen in rates of ICU readmission in the 2 groups. Use of a clinical care pathway may improve outcomes in patients undergoing total laryngectomy
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