Utilization of a Perioperative Care Pathway for Pediatric Alveolar Bone Grafting: A Quality Improvement Initiative

Abstract

Objective: To develop, implement, and evaluate a standardized perioperative care pathway for pediatric patients undergoing alveolar bone grafting from the anterior iliac crest.

Design: A historical control group of 40 patients was reviewed retrospectively and compared to a prospectively collected treatment group of 40 patients who were treated with the new pathway.

Setting: Tertiary-level academic pediatric hospital between 2018 and 2021.

Patients: Pediatric patients with nonsyndromic cleft lip and palate undergoing alveolar bone grafting.

Intervention: A perioperative clinical care pathway was specifically designed for patients undergoing alveolar bone grafting from the anterior iliac crest. The pathway involved standardization of perioperative care, ultrasound-guided regional anesthesia for both surgical sites, and scheduled postoperative analgesia.

Main outcome measures: (1) Length of hospital stay; (2) opioid consumption postoperatively; and (3) volume of oral intake in the first 24 h postoperatively. Data was analyzed via comparison of means (Student's t-test for continuous data and Chi-square test for categorical data) and control chart analysis.

Results: Compared to the control group, patients in the treatment group had lower mean length of stay (26.8 vs 37.8 h, p < .001), lower mean morphine consumption postoperatively (8 vs 34 mcg/kg, p = .008), and a higher proportion of patients not requiring any postoperative opioid use (80% vs 50%, p = .005).

Conclusions: Implementation of a standardized clinical care pathway for pediatric patients undergoing alveolar bone grafting from the anterior iliac crest is feasible and was associated with significant reductions in postoperative length of stay and postoperative opioid requirements.

Keywords: alveolar bone grafting; clinical care pathways; regional anesthesia.