Therapeutic, III.

BackgroundThe objective of this study is to evaluate the cost-effectiveness of a postoperative clinical care pathway for patients undergoing major head and neck oncologic surgery with microvascular reconstruction.MethodsThis is a comparative trial of a prospective treatment group managed on a postoperative clinical care pathway and a historical group managed prior to pathway implementation. Effectiveness outcomes evaluated were total hospital days, return to OR, readmission to ICU and rate of pulmonary complications. Costing perspective was from the government payer.Results118 patients were included in the study. All outcomes demonstrated that the postoperative pathway group was both more effective and less costly, and is therefore a dominant clinical intervention. The overall mean pre- and post-pathway costs are $22,733 and $16,564 per patient, respectively. The incremental cost reduction associated with the postoperative pathway was $6,169 per patient.ConclusionImplementing the postoperative clinical care pathway in patients undergoing head and neck oncologic surgery with reconstruction resulted in improved clinical outcomes and reduced costs.

A postoperative inpatient clinical care pathway in patients with head and neck cancer is associated with decreased health care utilization and inpatient costs in the 3 months after discharge. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1216-E1220, 2016.

Introduction. Optimal therapy for patients with metastatic neck disease remains controversial. Neck dissection following radiotherapy has traditionally been used to improve locoregional control. Methods. A retrospective review of 28 patients with node-positive head and neck malignancy treated with planned neck dissection following radiotherapy between January 2002 and December 2005 was performed to assess treatment outcomes. Results. Median interval to neck dissection was 9.6 weeks with a median number of 21 + 9 lymph nodes per specimen. Ten of 31 (32%) neck dissection specimens demonstrated evidence of residual carcinoma. Overall survival at two years was 85%; five-year overall survival was 65%. Concurrent chemotherapy did not impact the presence of residual neck disease. Conclusion. Based on the frequency of residual malignancy in the neck of patients treated with primary radiotherapy, a planned, postradiotherapy neck dissection should be strongly advocated for all patients with advanced-stage neck disease.

Objectives: 1) Describe the current evidence for middle-meatal steroid-eluting spacers in patients with chronic rhinosinusitis (CRS) following endoscopic sinus surgery (ESS) 2) Evaluate the need for postoperative systemic corticosteroids in CRS patients with nasal polyposis when using a steroid-eluting middle meatal spacer following ESS. Methods: CRS patients with nasal polyposis who failed medical therapy and elected ESS (n=36) were enrolled into this randomized, double-blind, placebo controlled trial. Patients were randomized into either a treatment arm (postoperative prednisone 30 mg once daily for 7 days; n=18) or placebo arm (placebo pill once daily for 7 days =18). Therapeutic outcomes were evaluated at 1 week, 3 weeks, and 2 months postoperatively. Primary outcome was endoscopic grading using the Lund-Kennedy scoring system. Secondary outcome included disease-specific quality of life (QoL) using the SNOT-22 survey. Results: Both study arms received significant improvement in endoscopic grading and disease-specific QoL from baseline compared to the two-month follow-up (p0.119). Conclusions: Minimizing the use of systemic corticosteroids in patients with CRS may avoid unwanted adverse events. Results from this study suggest that when using a middle meatal steroid-eluting spacer during ESS for patients with nasal polyposis, postoperative systemic corticosteroids may not significantly improve short-term endoscopic and disease-specific QoL.