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

Abstract

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. 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. 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. 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.