From Pathways to Practice: Impact of Implementing Mobilization Recommendations in Head and Neck Cancer Surgery with Free Flap Reconstruction
Abstract
:Simple Summary
Abstract
1. Background and Rationale
2. Materials and Methods
2.1. Setting and Participants
2.2. Early Mobilization Recommendations
- (1)
- The pathway and order set were modified to specify mobilization within 24 h instead of within 48 h (POD 2).
- (2)
- The pathway and order set were modified to specify foley catheter removal on POD 2 at the latest instead of POD 3.
- (3)
- Formal education sessions for unit nursing staff were developed and implemented. These sessions provided knowledge outlining the importance of early mobilization on postoperative recovery, and all unit staff attended the sessions.
2.3. Variables
2.4. Statistical Methods
3. Results
3.1. Recommendation Compliance
3.2. The Association between Compliance with Recommended Care and Postoperative Complications and LOS
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Institute of Medicine. Clinical Practice Guidelines We Can Trust; The National Academies Press: Washington, DC, USA, 2011. [Google Scholar] [CrossRef]
- Ryan, M.A. Adherence to Clinical Practice Guidelines. Otolaryngol. Neck Surg. 2017, 157, 548–550. [Google Scholar] [CrossRef]
- Lugtenberg, M.; Burgers, J.S.; Westert, G.P. Effects of evidence-based clinical practice guidelines on quality of care: A systematic review. Qual. Saf. Health Care 2009, 18, 385–392. [Google Scholar] [CrossRef]
- Sauro, K.M.; Wiebe, S.; Holroyd-Leduc, J.; DeCoster, C.; Quan, H.; Bell, M.; Jetté, N. Knowledge translation of clinical practice guidelines among neurologists: A mixed-methods study. PLoS ONE 2018, 13, e0205280. [Google Scholar] [CrossRef] [Green Version]
- Cabana, M.D.; Rand, C.S.; Powe, N.R.; Wu, A.W.; Wilson, M.H.; Abboud, P.-A.C.; Rubin, H.R. Why Don’t Physicians Follow Clinical Practice Guidelines? A framework for improvement. JAMA 1999, 282, 1458–1465. [Google Scholar] [CrossRef] [PubMed]
- Sutherland, K.; Levesque, J. Unwarranted clinical variation in health care: Definitions and proposal of an analytic framework. J. Eval. Clin. Pract. 2020, 26, 687–696. [Google Scholar] [CrossRef] [Green Version]
- Glasgow, R.E.; Eckstein, E.T.; ElZarrad, M.K. Implementation Science Perspectives and Opportunities for HIV/AIDS Research: Integrating science, practice, and policy. JAIDS J. Acquir. Immune Defic. Syndr. 2013, 63 (Suppl. S1), S26–S31. [Google Scholar] [CrossRef]
- Farquhar, C.M.; Kofa, E.W.; Slutsky, J.R. Clinicians’ attitudes to clinical practice guidelines: A systematic review. Med. J. Aust. 2002, 177, 502–506. [Google Scholar] [CrossRef]
- Grimshaw, J.; Thomas, R.E.; MacLennan, G.; Fraser, C.; Ramsay, C.R.; Vale, L.; Whitty, P.; Eccles, M.P.; Matowe, L.; Shirran, L.; et al. Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol. Assess. 2004, 8, 1–72. [Google Scholar] [CrossRef]
- Brindle, M.; Nelson, G.; Lobo, D.N.; Ljungqvist, O.; Gustafsson, U.O. Recommendations from the ERAS® Society for standards for the development of enhanced recovery after surgery guidelines. BJS Open 2020, 4, 157–163. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Ljungqvist, O.; Scott, M.; Fearon, K.C. Enhanced Recovery after Surgery: A review. JAMA Surg. 2017, 152, 292–298. [Google Scholar] [CrossRef]
- Dort, J.C.; Farwell, D.G.; Findlay, M.; Huber, G.F.; Kerr, P.; Shea-Budgell, M.; Simon, C.; Uppington, J.; Zygun, D.; Ljungqvist, O.; et al. Optimal Perioperative Care in Major Head and Neck Cancer Surgery With Free Flap Reconstruction: A consensus review and recommendations from the Enhanced Recovery After Surgery Society. JAMA Otolaryngol. Neck Surg. 2017, 143, 292–303. [Google Scholar] [CrossRef] [Green Version]
- Nelson, G.; Bakkum-Gamez, J.; Kalogera, E.; Glaser, G.; Altman, A.; Meyer, L.A.; Taylor, J.S.; Iniesta, M.; LaSala, J.; Mena, G.; et al. Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations—2019 update. Int. J. Gynecol. Cancer 2019, 29, 651–668. [Google Scholar] [CrossRef] [PubMed]
- Temple-Oberle, C.; Shea-Budgell, M.; Tan, M.; Semple, J.L.; Schrag, C.; Barreto, M.; Blondeel, P.; Hamming, J.; Dayan, J.; Ljungqvist, O. Consensus Review of Optimal Perioperative Care in Breast Reconstruction: Enhanced Recovery after Surgery (ERAS) Society Recommendations. Plast. Reconstr. Surg. 2017, 139, 1056e–1071e. [Google Scholar] [CrossRef]
- Cerantola, Y.; Valerio, M.; Persson, B.; Jichlinski, P.; Ljungqvist, O.; Hubner, M.; Kassouf, W.; Muller, S.; Baldini, G.; Carli, F.; et al. Guidelines for perioperative care after radical cystectomy for bladder cancer: Enhanced Recovery After Surgery (ERAS®) society recommendations. Clin. Nutr. 2013, 32, 879–887. [Google Scholar] [CrossRef] [PubMed]
- Yeung, J.K.; Dautremont, J.F.; Harrop, A.R.; Asante, T.; Hirani, N.; Nakoneshny, S.C.; De Haas, V.; McKenzie, D.; Matthews, T.W.; Chandarana, S.P.; et al. Reduction of Pulmonary Complications and Hospital Length of Stay with a Clinical Care Pathway after Head and Neck Reconstruction. Plast. Reconstr. Surg. 2014, 133, 1477–1484. [Google Scholar] [CrossRef] [PubMed]
- Vlug, M.S.; Bartels, S.A.L.; Wind, J.; Ubbink, D.T.; Hollmann, M.W.; Bemelman, W.A. Which fast track elements predict early recovery after colon cancer surgery? Color. Dis. 2011, 14, 1001–1008. [Google Scholar] [CrossRef]
- Twomey, R.; Matthews, T.W.; Nakoneshny, S.; Schrag, C.; Chandarana, S.; Matthews, J.; McKenzie, D.; Hart, R.D.; Li, N.; Dort, J.C.; et al. Impact of early mobilization on recovery after major head and neck surgery with free flap reconstruction. Cancers 2021. under review. [Google Scholar] [CrossRef]
- Coyle, M.J.; Main, B.; Hughes, C.; Craven, R.; Alexander, R.; Porter, G.; Thomas, S. Enhanced recovery after surgery (ERAS) for head and neck oncology patients. Clin. Otolaryngol. 2016, 41, 118–126. [Google Scholar] [CrossRef]
- Pisarska, M.; Pędziwiatr, M.; Małczak, P.; Major, P.; Ochenduszko, S.; Zub-Pokrowiecka, A.; Kulawik, J.; Budzyński, A. Do we really need the full compliance with ERAS protocol in laparoscopic colorectal surgery? A prospective cohort study. Int. J. Surg. 2016, 36, 377–382. [Google Scholar] [CrossRef]
- Low, G.M.; Kiong, K.L.; Amaku, R.; Kruse, B.; Zheng, G.; Weber, R.S.; Lewis, C.M. Feasibility of an Enhanced Recovery After Surgery (ERAS) pathway for major head and neck oncologic surgery. Am. J. Otolaryngol. 2020, 41, 102679. [Google Scholar] [CrossRef]
- Imai, T.; Kurosawa, K.; Asada, Y.; Momma, Y.; Takahashi, M.; Satake, N.; Azuma, M.; Suzuki, A.; Sasaki, M.; Morita, S.; et al. Enhanced recovery after surgery program involving preoperative dexamethasone administration for head and neck surgery with free tissue transfer reconstruction: Single-center prospective observational study. Surg. Oncol. 2020, 34, 197–205. [Google Scholar] [CrossRef] [PubMed]
- Jandali, D.B.; Vaughan, D.; Eggerstedt, M.; Ganti, A.; Scheltens, H.; Ramirez, E.A.; Revenaugh, P.C.; Al-Khudari, S.; Smith, R.M.; Stenson, K.M. Enhanced recovery after surgery in head and neck surgery: Reduced opioid use and length of stay. Laryngoscope 2020, 130, 1227–1232. [Google Scholar] [CrossRef]
- Gemma, M.; Toma, S.; Luce, F.L.; Beretta, L.; Braga, M.; Bussi, M. Enhanced recovery program (ERP) in major laryngeal surgery: Building a protocol and testing its feasibility. Acta Otorhinolaryngol. Ital. 2017, 37, 475–478. [Google Scholar] [CrossRef]
- Dort, J.C.; Sauro, K.M.; Schrag, C.; Chandarana, S.; Matthews, J.; Nakoneshny, S.; Manoloto, V.; Miller, T.; McKenzie, C.D.; Hart, R.D.; et al. Designing and integrating a quality management program for patients undergoing head and neck resection with free-flap reconstruction. J. Otolaryngol. Head Neck Surg. 2020, 49, 41. [Google Scholar] [CrossRef]
- Dort, J.C.; Sauro, K.M.; Chandarana, S.; Schrag, C.; Matthews, J.; Nakoneshny, S.; Manoloto, V.; Miller, T.; McKenzie, C.D.; Hart, R.D.; et al. The impact of a quality management program for patients undergoing head and neck resection with free-flap reconstruction: Longitudinal study examining sustainability. J. Otolaryngol. Head Neck Surg. 2020, 49, 42. [Google Scholar] [CrossRef] [PubMed]
- Clavien, P.A.; Barkun, J.; de Oliveira, M.L.; Vauthey, J.N.; Dindo, D.; Schulick, R.D.; de Santibañes, E.; Pekolj, J.; Slankamenac, K.; Bassi, C.; et al. The Clavien-Dindo Classification of Surgical Complications: Five-year experience. Ann. Surg. 2009, 250, 187–196. [Google Scholar] [CrossRef] [Green Version]
- StataCorp. Stata Statistical Software: Release 16; StataCorp LLC: College Station, TX, USA, 2019. [Google Scholar]
- Mehta, C.R.; Patel, N.R. A Network Algorithm for Performing Fisher’s Exact Test in r × c Contingency Tables. J. Am. Stat. Assoc. 1983, 78, 427. [Google Scholar] [CrossRef]
- Oxman, A.D.; Thomson, M.A.; A Davis, D.; Haynes, R.B. No magic bullets: A systematic review of 102 trials of interventions to improve professional practice. Can. Med. Assoc. J. 1995, 153, 1423–1431. [Google Scholar]
- Ivers, N.; Jamtvedt, G.; Flottorp, S.; Young, J.M.; Odgaard-Jensen, J.; French, S.D.; O’Brien, M.A.; Johansen, M.; Grimshaw, J.; Oxman, A.D. Audit and feedback: Effects on professional practice and healthcare outcomes. Cochrane Database Syst. Rev. 2012, 6, CD000259. [Google Scholar] [CrossRef]
- Neville, A.; Lee, L.; Antonescu, I.; Mayo, N.E.; Vassiliou, M.C.; Fried, G.M.; Feldman, L.S. Systematic review of outcomes used to evaluate enhanced recovery after surgery. BJS 2014, 101, 159–170. [Google Scholar] [CrossRef]
- Twomey, R.; Culos-Reed, S.N.; Daun, J.T.; Ferber, R.; Dort, J.C. Wearable activity trackers and mobilization after major head and neck cancer surgery: You can’t improve what you don’t measure—Perspective. Int. J. Surg. 2020, 84, 120–124. [Google Scholar] [CrossRef]
- Lang, K.; Menzin, J.; Earle, C.C.; Jacobson, J.; Hsu, M.-A. The Economic Cost of Squamous Cell Cancer of the Head and Neck: Findings from linked SEER-Medicare data. Arch. Otolaryngol. Head Neck Surg. 2004, 130, 1269. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Dautremont, J.F.; Rudmik, L.R.; Yeung, J.; Asante, T.; Nakoneshny, S.C.; Hoy, M.; Lui, A.; Chandarana, S.P.; Matthews, T.W.; Schrag, C.; et al. Cost-effectiveness analysis of a postoperative clinical care pathway in head and neck surgery with microvascular reconstruction. J. Otolaryngol. Head Neck Surg. 2013, 42, 59. [Google Scholar] [CrossRef] [Green Version]
- Varadarajan, V.V.; Arshad, H.; Dziegielewski, P.T. Head and neck free flap reconstruction: What is the appropriate post-operative level of care? Oral Oncol. 2017, 75, 61–66. [Google Scholar] [CrossRef]
- Rollins, K.E.; Lobo, D.N. Intraoperative Goal-directed Fluid Therapy in Elective Major Abdominal Surgery. Ann. Surg. 2016, 263, 465–476. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Hinther, A.; Nakoneshny, S.; Chandarana, S.; Matthews, T.; Hart, R.; Schrag, C.; Matthews, J.; McKenzie, C.; Fick, G.; Dort, J. Efficacy of Multimodal Analgesia for Postoperative Pain Management in Head and Neck Cancer Patients. Cancers 2021, 13, 1266. [Google Scholar] [CrossRef]
- Lane-Fall, M.B.; Cobb, B.T.; Cené, C.W.; Beidas, R.S. Implementation Science in Perioperative Care. Anesthesiol. Clin. 2018, 36, 1–15. [Google Scholar] [CrossRef] [PubMed]
- Alberta Innovates. ARECCI Ethics Guideline Tool. 2017. Available online: https://albertainnovates.ca/wp-content/uploads/2017/11/ARECCI-Ethics-Guideline-Tool.pdf (accessed on 1 January 2021).
Characteristic | All Cases n = 445 | Before n = 164 | After n = 281 | p-Value |
---|---|---|---|---|
Sex | ||||
Male | 303 (68) | 111 (68) | 192 (68) | 0.916 |
Female | 142 (32) | 53 (32) | 89 (32) | |
Age (years) | ||||
Mean ± SD | 61.2 ± 12.2 | 61.2 ± 11.6 | 61.2 ± 12.5 | 0.495 * |
Range | 21.2−89.0 | |||
Alcohol status | 0.027 | |||
Never | 90 (20) | 28 (17) | 62 (22) | |
Light/Moderate | 162 (36) | 47 (29) | 115 (41) | |
Heavy | 93 (21) | 44 (27) | 49 (17) | |
Former | 48 (11) | 17 (10) | 31 (11) | |
Not reported | 52 (12) | 28 (17) | 24 (9) | |
Smoking status | 0.304 | |||
Never smoked | 117 (26) | 35 (21) | 82 (29) | |
Former smoker | 151 (34) | 58 (35) | 93 (33) | |
Current smoker | 136 (31) | 51 (31) | 85 (30) | |
Not reported | 41 (9) | 20 (12) | 21 (8) | |
Comorbidities | 0.953 | |||
None | 142 (32) | 53 (32) | 89 (32) | |
One | 136 (31) | 51 (31) | 85 (30) | |
Two or more | 167 (37) | 60 (37) | 107 (38) | |
Specific Comorbidity(Present) | ||||
Diabetes | 54 (12) | 20 (12) | 34 (12) | 1.000 |
COPD | 50 (11) | 23 (14) | 27 (10) | 0.164 |
Hypertension | 181 (41) | 66 (40) | 115 (41) | 0.921 |
Heart disease | 59 (13) | 24 (15) | 35 (12) | 0.563 |
Primary site | ||||
Oral cavity | 303 (68) | 111 (68) | 192 (68) | 0.202 |
Pharynx and larynx | 42 (8) | 16 (10) | 26 (9) | |
Skin | 39 (9) | 9 (5) | 18 (6) | |
Paranasal/Nasal | 27 (6) | 10 (6) | 29 (10) | |
Other | 34 (8) | 18 (11) | 16 (6) | |
Histology | 0.152 | |||
Squamous cell | 356 (80) | 128 (78) | 228 (81) | |
Other cancer | 83 (18) | 30 (18) | 46 (16) | |
Benign | 6 (1) | 0 (0) | 6 (2) | |
Not reported | 7 (2) | 6 (4) | 1 (1) | |
Clinical stage | 0.507 | |||
0–II | 119 (27) | 41 (16) | 78 (28) | |
III–IV | 283 (65) | 99 (38) | 184 (66) | |
Not reported | 34 (8) | 118 46() | 16 (6) | |
Number of free flaps | 0.659 | |||
One | 423 (95) | 155 (95) | 268 (95) | |
Two | 22 (5) | 9 (5) | 13 (5) | |
Flap type | 0.113 | |||
Radial forearm | 235 (53) | 91 (55) | 144 (51) | |
Fibula | 95 (21) | 41 (25) | 54 (19) | |
Anterolateral thigh | 57 (13) | 16 (10) | 41 (15) | |
Other | 58 (13) | 16 (10) | 42 (15) | |
Resection extent | 0.173 | |||
Soft tissue | 329 (74) | 113 (69) | 216 (77) | |
Bone | 97 (22) | 42 (26) | 55 (20) | |
Soft tissue and bone | 19 (4) | 9 (5) | 10 (3) |
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Twomey, R.; Matthews, T.W.; Nakoneshny, S.C.; Schrag, C.; Chandarana, S.P.; Matthews, J.; McKenzie, D.; Hart, R.D.; Li, N.; Dort, J.C.; et al. From Pathways to Practice: Impact of Implementing Mobilization Recommendations in Head and Neck Cancer Surgery with Free Flap Reconstruction. Cancers 2021, 13, 2890. https://doi.org/10.3390/cancers13122890
Twomey R, Matthews TW, Nakoneshny SC, Schrag C, Chandarana SP, Matthews J, McKenzie D, Hart RD, Li N, Dort JC, et al. From Pathways to Practice: Impact of Implementing Mobilization Recommendations in Head and Neck Cancer Surgery with Free Flap Reconstruction. Cancers. 2021; 13(12):2890. https://doi.org/10.3390/cancers13122890
Chicago/Turabian StyleTwomey, Rosie, T. Wayne Matthews, Steven C. Nakoneshny, Christiaan Schrag, Shamir P. Chandarana, Jennifer Matthews, David McKenzie, Robert D. Hart, Na Li, Joseph C. Dort, and et al. 2021. "From Pathways to Practice: Impact of Implementing Mobilization Recommendations in Head and Neck Cancer Surgery with Free Flap Reconstruction" Cancers 13, no. 12: 2890. https://doi.org/10.3390/cancers13122890