Clinical pathway for abbreviated postoperative hospital stay in free tissue transfer to the head and neck: Impact in resource utilization and surgical outcomes

Abstract

Background

Assess the impact of a clinical pathway and progressive care unit (CPW/PCU) for patients undergoing head and neck free flap reconstruction with regard to patient outcomes and resource utilization.

Methods

Retrospective chart review of 270 patients at an academic tertiary‐care center (2009‐2014). Outcomes were compared among a control, CPW/PCU transition, and CPW/PCU groups.

Results

Compared to control, the CPW/PCU group had significantly reduced medical complications (21.1%‐4.1%), intensive care unit length of stay (LOS, 5.02‐0.2 days), hospital LOS (10.5‐6.2 days), standardized total charges ($88 270‐$58 661), and hospital costs ($41 365‐$22 680). There were no observed differences in flap viability, surgical complications, reoperations, or readmissions. The CPW/PCU group achieved 100% home discharge.

Conclusions

Our proposed CPW significantly improved patient outcomes and reduced resource utilization while maintaining flap outcomes. We propose a dynamic model for resource allocation that is easily reproducible in both academic and nonacademic settings.

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