The impact of clinical pathways on the practice of head and neck oncologic surgery: The University of Texas M.D. Anderson Cancer Center experience

Objective: To assess the impact of clinical pathways on the practice of head and neck oncologic surgery in an academic center. Design: Cross- sectional study. Setting: Cancer treatment center. Patients: The study population consisted of 3 groups of patients who underwent unilateral neck dissection and were treated in the Department of Head and Neck Surgery of the University of Texas M. D. Anderson Cancer Center, Houston. Additional procedures which may have been performed were direct laryngoscopy, rigid esophagoscopy, and/or dental extractions. Ninety-six patients treated during 1993-1994 prior to the implementation of the clinical pathway (historical control group) were compared with 94 patients treated during 1996-1998, 64 who were not (contemporaneous nonpathway group) and 30 who were managed on the clinical pathway (pathway group). Patients from 1995 were excluded since the pathway was in the planning stages then. Main Outcome Measures: Median length of stay; median total costs of care. Results: The median length of hospital stay of the historical control, contemporaneous nonpathway, and pathway groups decreased from 4.0 to 2.0 days (P<.001). The total median costs of care were less in the pathway group as compared with the historical control group ($6227 and $8459, respectively, P<.001) and also less in the contemporaneous nonpathway group compared with the historical control group ($6885 and $8459, respectively, P<.001). Mean and median length of hospital stay and costs were lower in the pathway group as compared with the nonpathway group but not significantly (P = .11 and P = .07, respectively) The contemporaneous nonpathway and pathway groups did not differ in complications or readmissions. Conclusions: Development and implementation of this clinical pathway played a statistically significant role in decreasing length of hospital stay and total costs of care associated with neck dissection between nonpathway and pathway patients. Thus, a more cost- effective practice environment has resulted for all of our patients.