Laryngectomy clinical pathway: Development and review

Objective: The goal of the study is to determine if the implementation of a protocol for the preoperative and postoperative care of patients receiving a laryngectomy for cancer of the larynx or hypopharynx (i.e., laryngectomy clinical pathway) reduced length and cost of hospital stay without increas ing complication rates. Design: This study is a comparison of the perioperative course of two group s of laryngectomy patients. Data were collected retrospectively from the re cords of patients operated on before the implementation of the clinical pat hway as the institutional historical control. Comparison was made with data collected prospectively on patients operated on after the implementation o f the clinical pathway. Setting: The study was performed at a mid-sized teaching hospital associate d with two regional cancer centres. All surgeries were performed by one of two otolaryngology-head and neck surgeons and residents under their supervi sion. Methods: The demographic, patient, tumour, treatment, dietary, and complica tion data were analyzed. Fisher's exact (two-tailed) statistical test was u sed for parametric data and Wilcoxon scores for nonparametric data. Main Outcome Measure: The principal outcome measure was the length of posto perative inpatient stay. Secondary outcome measures were readmissions and p ostoperative complications. Results: There was a statistically significant decrease of 6.7 days in the mean length of hospitalization in the clinical pathway group even when taki ng postoperative readmissions into account. There was no concomitant increa se in surgical complications. The mean reduction in hospital cost per case was calculated to be $3420 (Can). Conclusions: Application of a clinical pathway for patients receiving laryn gectomy is both feasible and effective.