2017 Volume 17 Issue 4 Pages 185-191
Since September 2005, we have used a critical path system to manage perioperative medical care for patients undergoing cervical laminoplasty. Variance analysis of the outcomes and duration of postoperative hospitalization identified key points for the smooth management of a critical path dealing with a long period of postoperative hospitalization. Cervical laminoplasty is a form of elective surgery, and as long as complications are well controlled preoperatively, there is little likelihood of variance occurring in the anticipated outcome. When the outcome was defined as the duration of postoperative hospitalization, however, the wishes and schedules of patients and their family members accounted for three-quarters of negative variance, and reducing this factor posed a challenge. We changed our method of management in December 2012, improving patient education by providing clear information on discharge criteria and the expected date of discharge from before surgery, and giving them guidance on post-discharge lifestyle at an early postoperative stage. This greatly reduced the negative variance due to the wishes and schedules of patients and their family members. The important points that we identified for the smooth management of a critical path dealing with a long period of postoperative hospitalization of more than 2 weeks were the prevention of perioperative complications and comorbidities through preoperative physical testing and through improved patient education on pre-existing conditions, dealing with patients on an individual basis in accordance with postoperative course, and taking care to ensure that patients and their family members understand the disease and course of treatment in the preoperative stage. Moreover, with the intent to detect postoperative neurological deficits as early as possible, we equipped the critical path system with the check function.
