A Comprehensive Clinical Care Pathway for Microvascular Maxillofacial Reconstructive Surgery

Haider Abo Sharkh; Sreenath Madathil; Osama Al-Ghamdi; Ramanakumar V Agnihotram; Avinash Sinha; Michel El-Hakim; Belinda Nicolau; Nicholas Makhoul

doi:10.1016/j.joms.2019.04.027

A Comprehensive Clinical Care Pathway for Microvascular Maxillofacial Reconstructive Surgery

J Oral Maxillofac Surg. 2019 Nov;77(11):2347-2354. doi: 10.1016/j.joms.2019.04.027. Epub 2019 May 7.

Authors

Haider Abo Sharkh¹, Sreenath Madathil², Osama Al-Ghamdi³, Ramanakumar V Agnihotram⁴, Avinash Sinha⁵, Michel El-Hakim⁶, Belinda Nicolau⁷, Nicholas Makhoul⁸

Affiliations

¹ Fellow in Maxillofacial Oncology and Microvascular Reconstruction, Department of Oral and Maxillofacial Surgery, McGill University Health Center, Montreal, Quebec, Canada.
² Research Director, Department of Oral and Maxillofacial Surgery, McGill University Health Center, Montreal, Quebec, Canada.
³ Previous Fellow in Maxillofacial Oncology and Microvascular Reconstruction, Department of Oral and Maxillofacial Surgery, McGill University Health Center, Montreal, Quebec, Canada.
⁴ Adjunct Professor, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada.
⁵ Assistant Professor, Department of Anesthesia, Montreal General Hospital, McGill University Health Center, Montreal, Quebec, Canada.
⁶ Assistant Professor, Department of Oral and Maxillofacial Surgery, McGill University Health Center, Montreal, Quebec, Canada.
⁷ Associate Professor, Division of Oral Health and Society, Faculty of Dentistry, McGill University, Montreal, Quebec, Canada.
⁸ 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: nicholas.makhoul@mcgill.ca.

PMID: 31153941
DOI: 10.1016/j.joms.2019.04.027

Abstract

Purpose: 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.

Materials and 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.

Conclusion: Our results underscore the importance of standardized evidence-based patient care through CCPs for complex patient populations.

MeSH terms

Bayes Theorem
Critical Pathways*
Humans
Length of Stay
Orthognathic Surgical Procedures*
Patient Discharge
Patient Readmission
Plastic Surgery Procedures*
Postoperative Complications
Retrospective Studies
Surgery, Oral*