Publication type: Article in scientific journal
Type of review: Peer review (publication)
Title: Association of multiprofessional preoperative assessment and information for patients with head and neck cancer with postoperative outcomes
Authors: Schmid, Manuela
Giger, Roland
Nisa, Lluís
Mueller, Simon Andreas
Schubert, Maria
Schubert, Adrian Daniel
et. al: No
DOI: 10.1001/jamaoto.2021.4048
Published in: JAMA Otolaryngology–Head & Neck Surgery
Volume(Issue): 148
Issue: 3
Page(s): 259
Pages to: 267
Issue Date: 20-Jan-2022
Publisher / Ed. Institution: American Medical Association
ISSN: 2168-6181
Language: English
Subject (DDC): 616: Internal medicine and diseases
Abstract: Importance: Multidisciplinary perioperative assessment for patients undergoing complex oncologic head and neck cancer (HNC) surgery is widely implemented. However, to our knowledge, the association of multiprofessional preoperative assessment, information, and briefing with postoperative outcomes has not been evaluated. Objective: To compare postoperative complications, length of hospital stay (LOS), readmissions, mortality, and costs per case among patients undergoing complex oncologic HNC surgery before and after the implementation of a comprehensive preoperative multiprofessional assessment and information day (MUPAID). Design, Setting, and Participants: This retrospective, single-center case-control study was conducted at a tertiary referral head and neck anticancer center/university cancer institute and compared patients with HNC who were undergoing complex oncological surgeries between January 2012 and July 2018 before (control group) and after (intervention group) implementation of the institutional MUPAID. Data analysis was conducted between 2019 and 2020. The intervention group comprised patients who participated in the MUPAID beginning in February 2015. These patients were assessed by a multiprofessional team and provided with structured and comprehensive information on the surgical procedure and its functional, social, financial, and psychological effects, as well as the postoperative care, rehabilitation, and follow-up period. Patients in the control group had also undergone complex oncologic HNC surgery and were selected through surgical procedure codes. Main Outcomes and Measures: The end points were postoperative rate and severity of complications, LOS, readmissions, mortality, and costs per case. Results: The study included 161 patients, 81 in the intervention (25 women [30.9%]) and 80 in the control group (18 women [22.5%]). The groups showed no relevant differences in sociodemographic, disease, and procedural characteristics. The intervention cohort presented with fewer major local and systemic complications (Clavien-Dindo score, III-V: 34.6% vs 52.5%; difference proportion, −0.179; 95% CI, −0.33 to −0.03), shorter median LOS (12 days [IQR, 10-16 days] vs 16 days [IQR, 11-20] days; effect size, 0.482; 95% CI Cohen d, 0.152-0.812) and decreased median charge per case ($50 848 [IQR, $42 510-$63 479] vs $69 602 [IQR, $45 631-$96 280]; effect size, 0.534; 95% CI Cohen d, 0.22-0.85). Conclusions and Relevance: The results of this case-control study suggest that MUPAID for patients who are undergoing complex oncologic HNC surgery is associated with shortened LOS and costs per case as well as decreased complications severity. These results are promising on a patient level in the potential to minimize individual treatment burden, as well as on an institutional and health care system level in the potential significant optimization of surgical outcomes and financial aspects.
Fulltext version: Published version
License (according to publishing contract): Licence according to publishing contract
Departement: School of Health Sciences
Organisational Unit: Institute of Nursing (IPF)
Appears in collections:Publikationen Gesundheit

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