Ann Surg Treat Res.  2019 Nov;97(5):239-244. 10.4174/astr.2019.97.5.239.

The effectiveness of an enhanced recovery after surgery protocol in head and neck cancer surgery with free-flap reconstruction

• Won HR
• An JY
• Lee JJ
• Kim DY
• Jang JY
• Kim CH
• Shin YS

• KMID: 2461899
• DOI: http://doi.org/10.4174/astr.2019.97.5.239

Abstract

PURPOSE
An enhanced recovery after surgery (ERAS) protocol incorporates up-to-date perioperative care principles; the primary aim in using an ERAS protocol is to reduce issues that delay the recovery and cause the complications. The aim of this study was to compare outcomes associated with head and neck cancer surgery with free-flap reconstruction before and after implementation of an ERAS protocol.
METHODS
Outcomes were analyzed by dividing patients into 2 groups: 29 patients in the non-ERAS group and 60 patients in the ERAS group. The ERAS group performed a prospective observational cohort study of patients who underwent a head and neck cancer surgery with free-flap reconstruction in Ajou University Hospital from August 2015 to December 2017. The non-ERAS group retrospectively reviewed the medical records of patients who had undergone the same surgery from August 2012 to July 2015.
RESULTS
Demographics, comorbidities, hospital length of stay (LOS), postoperative complications, starting time of rehabilitation, and postoperative periods before radiotherapy for the non-ERAS and ERAS groups were compared. Hospital LOS was significantly lower for patients whose care followed the ERAS protocol than for patients in the non-ERAS group (30.87 ± 20.72 days vs. 59.66 ± 40.43 days, P < 0.0001).
CONCLUSION
In this study, hospital LOS was reduced through fast recovery after the implementation of the ERAS protocol. Therefore, the ERAS protocol appeared feasible and safe in head and neck cancer surgery with free-flap reconstruction.

Keyword

Adjuvant radiotherapy; Free tissue flaps; Head and neck neoplasms; Perioperative care; Postoperative care

MeSH Terms

Cohort Studies
Comorbidity
Demography
Free Tissue Flaps
Head and Neck Neoplasms*
Head*
Humans
Length of Stay
Medical Records
Perioperative Care
Postoperative Care
Postoperative Complications
Postoperative Period
Prospective Studies
Radiotherapy
Radiotherapy, Adjuvant
Rehabilitation
Retrospective Studies

Figure

• 

  Fig. 1 Hospital LOS of all patients. The mean hospital LOS of 27 patients in the non-ERAS protocol group was 59.66 ± 40.43 days, and the mean hospital LOS of 60 patients in the ERAS protocol group was 30.87 ± 20.73 days (P < 0.001). ERAS, enhanced recovery after surgery; LOS, length of stay.

Reference

1. Coyle MJ, Main B, Hughes C, Craven R, Alexander R, Porter G, et al. Enhanced recovery after surgery (ERAS) for head and neck oncology patients. Clin Otolaryngol. 2016; 41:118–126.

2. Dort JC, Farwell DG, Findlay M, Huber GF, Kerr P, Shea-Budgell MA, 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 Head Neck Surg. 2017; 143:292–303.

3. Kwag SJ, Kim JG, Kang WK, Lee JK, Oh ST. The nutritional risk is a independent factor for postoperative morbidity in surgery for colorectal cancer. Ann Surg Treat Res. 2014; 86:206–211.

4. Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth. 1997; 78:606–617.

5. Bianchini C, Pelucchi S, Pastore A, Feo CV, Ciorba A. Enhanced recovery after surgery (ERAS) strategies: possible advantages also for head and neck surgery patients. Eur Arch Otorhinolaryngol. 2014; 271:439–443.

6. Kehlet H. Organizing postoperative accelerated recovery programs. Reg Anesth. 1996; 21:6 Suppl. 149–151.

7. Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg. 2017; 152:292–298.

8. Nicholson A, Lowe MC, Parker J, Lewis SR, Alderson P, Smith AF. Systematic review and meta-analysis of enhanced recovery programmes in surgical patients. Br J Surg. 2014; 101:172–188.

9. Xu W, Daneshmand S, Bazargani ST, Cai J, Miranda G, Schuckman AK, et al. Postoperative pain management after radical cystectomy: comparing traditional versus enhanced recovery protocol pathway. J Urol. 2015; 194:1209–1213.

10. Jeong O, Ryu SY, Park YK. Postoperative functional recovery after gastrectomy in patients undergoing enhanced recovery after surgery: a prospective assessment using standard discharge criteria. Medicine (Baltimore). 2016; 95:e3140.

11. Sjetne IS, Krogstad U, Odegard S, Engh ME. Improving quality by introducing enhanced recovery after surgery in a gynaecological department: consequences for ward nursing practice. Qual Saf Health Care. 2009; 18:236–240.

12. Bernier J, Cooper JS. Chemoradiation after surgery for high-risk head and neck cancer patients: how strong is the evidence? Oncologist. 2005; 10:215–224.