DMAIC Approach to Reduce LOS in Patients Undergoing Oral Cancer Surgery

Introduction. Maxillary and mandibular cancer represents the sites where cystic and neoplastic conditions, of a benign or malignant nature, can occur. In general, for patients undergoing surgery to remove cancer of the oral cavity, the administration of oral antibiotics, Ceftriaxone and Cefazolin plus Clindamycin, can affect the Length of Stay (LOS). Objective. The objective of this study is to evaluate the efficacy of administering two antibiotics (Ceftriaxone and Cefazolin plus Clindamycin) through the statistical analysis of LOS in patients undergoing oral cancer surgery (mucosa/bone) at the Department of Maxillofacial Surgery of the University of Naples “Federico II”. Methods. The retrospective study was carried out to compare the efficacy of administering two antibiotics by analysing postoperative LOS in two different groups of patients by applying the Six Sigma (SS) methodology which follows the Define, Measure, Analyse, Improve, Control - cycle. Statistical tests were carried out during the Analyse stage to investigate the variables which could effectively influence the LOS of the two groups. A demographic study was conducted by applying the chi square test for each variable. Results. A statistically significant decrease in LOS was shown in patients not undergoing lymphadenectomy and in patients not exposed to surgical site infections treated with Ceftriaxone. A statistically significant difference in frequency (chi square test) was obtained based on the American Society of Anaesthesiologists score. Conclusions. This study showed the validity of the SS methodology for evaluating the efficacy of the administration of antibiotics in patients undergoing surgery for oral cancer.