Abstract
Purpose
Clinical pathways have contributed to standardized postoperative management, but analyzing variance is also important to maintain quality control. To evaluate the validity of our own clinical pathway for managing video-assisted lobectomy for lung cancer, we analyzed the variances influencing postoperative recovery.
Methods
Between April 2003 and April 2004, 62 consecutive patients with lung cancer underwent video-assisted single anatomic lobectomy with lymph node dissection. We evaluated 61 of these patients after the exclusion of one, who deviated from the clinical pathway management immediately as a result of serious complications.
Results
There were 29 men and 32 women, with an average age of 65.7 years. Complications developed in 29 patients, but there was no operative mortality. The occurrence of variance ranged from 1.6% to 34.4% for each activity and included prolonged supplemental oxygen therapy, out-of routine examination, prolonged epidural anesthesia, and delayed bathing frequently. Complications and an abnormal body mass index were significant and independent clinical factors affecting the increase in variance.
Conclusions
Our original clinical pathway management was tolerable for lung cancer patients undergoing a video-assisted lobectomy. Complications and an abnormal body mass index were significant predictive factors for an increase in variance of our clinical pathway.
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References
Pearson SD, Goulart-Fisher D, Lee TH. Critical pathways as a strategy for improving care: problems and potential. Ann Intern Med 1995;123:941–948.
Coffey RJ, Othman JE, Walters JI. Extending the application of critical path methods. Qual Manag Health Care 1995;3:14–29.
Nakata M, Saeki T, Yokoyama N, Kurita A, Takiyama W, Takashima S. Pulmonary function after lobectomy: video-assisted thoracic surgery versus thoracotomy. Ann Thorac Surg 2000;70:938–941.
Wright CD, Wain JC, Grillo HC, Moncure AC, Macaluso SM, Mathisen DJ. Pulmonary lobectomy patient care pathway: A model to control cost and maintain quality. Ann Thorac Surg 1997;64:299–302.
Kirby TJ, Mack MJ, Landreneau RJ, Rice TW. Lobectomy videoassisted thoracic surgery versus muscle-sparing thoracotomy. A randomized trial. J Thorac Cardiovasc Surg 1995;109:997–1002.
Koizumi K, Tanaka S, Haraguchi S, Akiyama H, Mikami I, Fukushima M, et al. Lobectomy by video-assisted thoracic surgery for primary lung cancer: experiences based on provisional indications. Surg Today 1998;28:36–40.
Zander K. Care maps: the core of cost/quality care. New Definition 1991;6:1–3.
Schriefer J. Managing critical pathway variances. Qual Manag Health Care 1995;3:30–42.
Coffey RJ, Richards JS, Remmert CS, LeRoy SS, Schoville RR, Baldwin PJ. An introduction to critical paths. Qual Manag Health Care 1992;1:45–54.
Hyett KL, Podosky M, Santamaria N, Ham JC. Valuing variance: the importance of variance analysis in clinical pathways utilisation. Aust Health Rev 2007;31:565–570.
Tovar EA, Roethe RA, Weissig MD, Lloyd RE, Patel GR. Oneday admission for lung lobectomy: an incidental result of a clinical pathway. Ann Thorac Surg 1998;65:803–806.
Zehr KJ, Dawson PB, Yang SC, Heitmiller RF. Standard clinical care pathways for major thoracic cases reduce hospital costs. Ann Thorac Surg 1998;66:914–919.
Cerfolio RJ, Pickens A, Bass C, Katholi C. Fast-tracking pulmonary resections. J Thorac Cardiovasc Surg 2001;122:318–324.
Ueda K, Kaneda Y, Sakano H, Tanaka T, Li TS, Hamano K. Obstacles for shortening hospitalization after video-assisted pulmonary resection for lung cancer. Ann Thorac Surg 2003;76:1816–18120.
Maruyama R, Miyake T, Kojo M, Aoki Y, Suemitsu R, Okumoto T, et al. Establishment of a clinical pathway as an effective tool to reduce hospitalization and charges after video-assisted thoracoscopic pulmonary resection. Jpn J Thorac Cardiovasc Surg 2006;54:387–390.
Tovar EA. Minimally invasive approach for pneumonectomy culminating in an outpatient procedure. Chest 1998;114:1454–1458.
Smith PW, Wang H, Gazoni LM, Shen KR, Daniel TM, Jones DR. Obesity does not increase complications after anatomic resection for non-small cell lung cancer. Ann Thorac Surg 2007;84:1098–1105.
Win T, Ritchie AJ, Wells FC, Laroche CM. The incidence and impact of low body mass index on patients with operable lung cancer. Clin Nutr 2007;26:440–443.
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Okita, A., Yamashita, M., Abe, K. et al. Variance analysis of a clinical pathway of video-assisted single lobectomy for lung cancer. Surg Today 39, 104–109 (2009). https://doi.org/10.1007/s00595-008-3821-8
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DOI: https://doi.org/10.1007/s00595-008-3821-8