A Standardized Perioperative Clinical Pathway for Uncomplicated Craniosynostosis Repair Is Associated With Reduced Hospital Resource Utilization.

ABSTRACT

BACKGROUND: Hospital resource overutilization can significantly disrupt patient treatment such as cancelling surgical patients due to a lack of intensive care unit (ICU) space. The authors describe a clinical pathway (CP) designed to reduce ICU length of stay (LOS) for nonsyndromic single-suture craniosynostosis (nsSSC) patients undergoing cranial vault reconstruction (CVR) in order to minimize surgical disruptions and improve patient outcomes. METHODS: A multidisciplinary team implemented a perioperative CP including scheduled laboratory testing to decrease ICU LOS. Hospital and ICU LOS, interventions, and perioperative morbidity-infection rate, cerebrospinal fluid (CSF) leaks, and unplanned return to the operating room (OR)-were compared using Mann-Whitney U, Fisher exact, and t tests. RESULTS: Fifty-one ICU admissions were managed with the standardized CP and compared to 49 admissions in the 12 months prior to pathway implementation. There was a significant reduction in ICU LOS (control mean 1.84 ±â€Š0.93, median 1.89 ±â€Š0.94; CP mean 1.15 ±â€Š0.34, median 1.03 ±â€Š0.34 days; P < 0.001 for both). There were similar rates of hypotension requiring intervention (CP 2, control 1; P = 0.999), postoperative transfusion (CP 3, control 0; P = 0.243), and artificial ventilation (CP 1, control 0; P = 0.999). Perioperative morbidity such as infection (CP 1, control 0; P = 0.999), return to the OR (CP 1, control 0; P = 0.999), and CSF leak (no leaks; P = 0.999) was also similar. CONCLUSION: Implementation of a standardized perioperative CP for nsSSC patients resulted in a significantly shorter ICU LOS without a measured change in perioperative morbidity. Pathways such as the one described that improve patient throughput and decrease resource utilization benefit craniofacial teams in conducting an efficient service while providing high-quality care.