Decreased Complications After Total Laryngectomy Using a Clinical Care Pathway

Area of Science:

• Otolaryngology
• Surgical Outcomes
• Quality Improvement

Background:

• Complications after total laryngectomy increase hospital length of stay (LOS) and healthcare costs.
• A standardized clinical care pathway may mitigate these adverse outcomes.
• Evaluating the efficacy of such pathways is crucial for optimizing patient care.

Purpose of the Study:

• To determine the effectiveness of a clinical care pathway in improving outcomes for patients undergoing total laryngectomy.
• To assess the impact of the pathway on complication rates, hospital LOS, and readmissions.
• To identify potential benefits for patients undergoing primary or salvage total laryngectomy.

Main Methods:

• Quality improvement study involving adult patients undergoing total laryngectomy (primary or salvage).
• Data collected from January 2013 to December 2018 at a tertiary referral center.
• Primary outcome: hospital LOS; secondary outcomes: complication frequencies, 30-day readmission rates, and ICU LOS.

Main Results:

• Sixty-three patients were analyzed: 29 pre-pathway and 34 post-pathway implementation.
• The post-pathway group showed a trend towards lower total complication rates (RR=0.5; 95% CI 0.3-1.0).
• No significant differences were observed in median hospital LOS, 30-day readmission rates, or ICU readmission rates between the groups.

Conclusions:

• Implementation of a postoperative order set pathway for total laryngectomy patients is associated with reduced overall complication rates.
• Clinical care pathways may offer a valuable strategy for improving outcomes in laryngectomy patients.
• Further research may explore specific pathway components influencing complication reduction.