The impact of clinical pathways on the practice of head and neck oncologicsurgery - The University of Texas MD Anderson Cancer Center experience

Objective: To assess the impact of clinical pathways on the practice of hea d and neck oncologic surgery in an academic center. Design: Cross-sectional study. Setting: Cancer treatment center. Patients: The study population consisted of 3 groups of patients who underw ent unilateral neck dissection and were treated in the Department of Head a nd Neck Surgery of the University of Texas M. D. Anderson Cancer Center, Ho uston. Additional procedures which may have been performed were direct lary ngoscopy, rigid esophagoscopy, and/or dental extractions. Ninety-six patien ts treated during 1993-1994 prior to the implementation of the clinical pat hway (historical control group) were compared with 94 patients treated duri ng 1996-1998, 64 who were not (contemporaneous nonpathway group) and 30 who were managed on the clinical pathway (pathway group). Patients from 1995 w ere excluded since the pathway was in the planning stages then. Main Outcome Measures: Median length of stay; median total costs of care. Results: The median length of hospital stay of the historical control, cont emporaneous nonpathway, and pathway groups decreased from 4.0 to 2.0 days ( P<.001). The total median costs of care were less in the pathway group as c ompared with the historical control group ($6227 and $8459, respectively, P <.001) and also less in the contemporaneous nonpathway group compared with the historical control group ($6885 and $8459, respectively, P<.001). Mean and median length of hospital stay and costs were lower in die pathway grou p as compared with the nonpathway group but not significantly (P = .11 and P = .07, respectively) The contemporaneous nonpathway and pathway groups di d not differ in complications or readmissions. Conclusions: Development and implementation of this clinical pathway played a statistically significant role in decreasing length of hospital stay and total costs of care associated with neck dissection between nonpathway and pathway patients. Thus, a more cost-effective practice environment has res ulted for all of our patients.