Cost-effectiveness analysis of a postoperative clinical care pathway in head and neck surgery with microvascular reconstruction

Abstract

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.

Understanding the impact of a clinical care pathway for major head and neck cancer resection on postdischarge healthcare utilization

“…Our postoperative care pathway is associated with decreased health care utilization and inpatient costs in the 3 months after discharge from the hospital. We have previously reported that our pathway significantly reduced costs during the inpatient recovery period . Studying postdischarge resource utilization allowed us to determine if well‐designed and delivered inpatient care had persistent effects even after discharge from the hospital.…”

“…Pathways outline the timing and coordination of all essential interventions provided by multiple health care disciplines in order to minimize delays, omissions, and duplications of care and therefore maximize effectiveness and efficiency . We have previously shown that implementation of a postoperative care pathway in patients undergoing major head and neck oncologic surgery with microvascular reconstruction was cost‐effective during the inpatient recovery period …”

Predictive value of the ACS NSQIP calculator for head and neck reconstruction free tissue transfer

“…In addition, well over a quarter of patients experience some postoperative complication such as pneumonia, wound disruption, and cardiac events . Knowledge of these potential complications can be used to counsel patients during the informed consent process . Because patients undergoing head and neck free tissue transfer are often of advanced age, present with multiple comorbidities, have a history of alcohol and tobacco use, and may have history of prior chemoradiation, any additional patient‐specific information regarding surgical risk would be useful in the clinical decision‐making process.…”

Human papillomavirus–associated oropharyngeal squamous cell carcinoma and anogenital cancers in men: Epidemiologic evaluation of association

“…Other oncogenic HPVs are rarely detected in head and neck cancers . Molecular and epidemiologic studies suggest that HPV‐positive OPSCC comprise a distinct disease entity, which has a better prognosis . Immunohistochemistry using p16 has been used as a surrogate marker of oncogenic HPV and is now widely accepted …”