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Optimizing Outcomes After Cleft Palate Repair: Design and Implementation of a Perioperative Clinical Care Pathway.
Cawthorn, Thomas R; Todd, Anna R; Hardcastle, Nina; Spencer, Adam O; Harrop, A Robertson; Fraulin, Frankie O G.
Afiliación
  • Cawthorn TR; Section of Plastic Surgery, Department of Surgery, University of Calgary, Alberta, Canada.
  • Todd AR; Section of Plastic Surgery, Department of Surgery, University of Calgary, Alberta, Canada.
  • Hardcastle N; Section of Pediatric Anesthesiology, Department of Anesthesiology, University of Calgary, Alberta, Canada.
  • Spencer AO; Section of Pediatric Anesthesiology, Department of Anesthesiology, University of Calgary, Alberta, Canada.
  • Harrop AR; Sections of Pediatric Surgery and Plastic Surgery, Department of Surgery, University of Calgary, Alberta, Canada.
  • Fraulin FOG; Sections of Pediatric Surgery and Plastic Surgery, Department of Surgery, University of Calgary, Alberta, Canada.
Cleft Palate Craniofac J ; 59(5): 561-567, 2022 05.
Article en En | MEDLINE | ID: mdl-34000856
OBJECTIVE: To evaluate the development process and clinical impact of implementing a standardized perioperative clinical care pathway for cleft palate repair. DESIGN: Medical records of patients undergoing primary cleft palate repair prior to pathway implementation were retrospectively reviewed as a historical control group (N = 40). The historical cohort was compared to a prospectively collected group of patients who were treated according to the pathway (N = 40). PATIENTS: Healthy, nonsyndromic infants undergoing primary cleft palate repair at a tertiary care pediatric hospital. INTERVENTIONS: A novel, standardized pathway was created through an iterative process, combining literature review with expert opinion and discussions with institutional stakeholders. The pathway integrated multimodal analgesia throughout the perioperative course and included intraoperative bilateral maxillary nerve blocks. Perioperative protocols for preoperative fasting, case timing, antiemetics, intravenous fluid management, and postoperative diet advancement were standardized. MAIN OUTCOME MEASURES: Primary outcomes include: (1) length of hospital stay, (2) cumulative opioid consumption, (3) oral intake postoperatively. RESULTS: Patients treated according to the pathway had shorter mean length of stay (31 vs 57 hours, P < .001), decreased cumulative morphine consumption (77 vs 727 µg/kg, P < .001), shorter time to initiate oral intake (9.3 vs 22 hours, P = .01), and greater volume of oral intake in first 24 hours postoperatively (379 vs 171 mL, P < .001). There were no differences in total anesthesia time, total surgical time, or complication rates between the control and treatment groups. CONCLUSIONS: Implementation of a standardized perioperative clinical care pathway for primary cleft palate repair is safe, feasible, and associated with reduced length of stay, reduced opioid consumption, and improved oral intake postoperatively.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Fisura del Paladar Tipo de estudio: Guideline / Observational_studies / Risk_factors_studies Límite: Child / Humans / Infant Idioma: En Revista: Cleft Palate Craniofac J Asunto de la revista: ODONTOLOGIA Año: 2022 Tipo del documento: Article País de afiliación: Canadá Pais de publicación: Estados Unidos
Texto completo
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Imprimir
XML
PubMed Links
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Fisura del Paladar Tipo de estudio: Guideline / Observational_studies / Risk_factors_studies Límite: Child / Humans / Infant Idioma: En Revista: Cleft Palate Craniofac J Asunto de la revista: ODONTOLOGIA Año: 2022 Tipo del documento: Article País de afiliación: Canadá Pais de publicación: Estados Unidos