A Comprehensive Clinical Care Pathway for Microvascular Maxillofacial Reconstructive Surgery.


Director and Associate Professor, Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, McGill University, and Chief, Department of Dentistry and Oral and Maxillofacial Surgery, McGill University Health Centre, Montreal, Quebec, Canada. Electronic address: [Email]


OBJECTIVE : Clinical care pathways (CCPs) for major surgical procedures are less developed. We describe the development of a comprehensive microvascular maxillofacial reconstruction CCP and evaluate the impact.
METHODS : Our team developed a comprehensive CCP for patients undergoing microvascular free flap reconstruction for benign or malignant tumors. Patient data before (n = 48) and after (n = 47) implementation of the CCP were used to evaluate the impact. Bayesian negative binomial and logistic regression analyses were used to estimate the associations between the CCP and clinical outcomes (length of stay [LOS], readmission to the operating room, and readmission within 3 months of discharge).
RESULTS : The average total hospital LOS was high in the pre-CCP group (16.9 days) compared with the post-CCP group (9.8 days). Being in the post-CCP group reduced the LOS in the intensive care unit and surgical ward and reduced the risk of readmission to the operating room.
CONCLUSIONS : Our results underscore the importance of standardized evidence-based patient care through CCPs for complex patient populations.

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