Efficacy of a high‐observation protocol in major head and neck cancer surgery: A prospective study

Barber, Brittany; Harris, Jeffrey R.; Shillington, Cameron; Rychlik, Shannon; Dort, Joseph C.; Meier, Michael; Estey, Angela; Elwi, Adam; Wickson, Patty; Buss, Michael; Zygun, David; Ansari, Kal; Biron, Vincent L.; O’Connell, Daniel A.; Seikaly, Hadi

doi:10.1002/hed.24599

Cited by 4 publications

(8 citation statements)

References 20 publications

(35 reference statements)

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“…31,32 An increasing body of work has also shown that post-operative free-flap monitoring is safe in appropriately selected head and neck cancer patients outside the intensive care unit. 20,22,23,30,33 Just under half of the patients in our cohort were mechanically ventilated, and the overall short patient length of stay in the intensive care unit suggests that some of the patients in our study admitted to the intensive care unit might have been suitable for post-operative care using an alternative pathway, freeing intensive care unit resources for other patients and decreasing the overall cost of each patient's admission.…”

Section: Discussionmentioning

confidence: 93%

Outcomes for head and neck cancer patients admitted to intensive care in Australia and New Zealand between 2000 and 2016

et al. 2021

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Objective To report intensive care unit admission outcomes for head and neck cancer patients. Methods A retrospective, observational cohort analysis of all Australian and New Zealander head and neck cancer patient intensive care unit admissions from January 2000 to June 2016, including data from 192 intensive care units. Results There were 10 721 head and neck cancer patients, with a median age of 64 years (71.6 per cent male). Of admissions, 76.4 per cent were in public hospitals, 96.9 per cent were post-operative and 43.6 per cent required mechanical ventilation. Annual head and neck cancer admissions increased from 2000 to 2015 (from 348 to 1132 patients), but the overall proportion of intensive care unit admissions remained constant. In-hospital mortality was 2.7 per cent, and intensive care unit mortality was 0.7 per cent. The in-hospital mortality risk decreased three-fold (p < 0.001). Conclusion Head and neck cancer patients had low mortality in the intensive care unit and in hospital. Risk of dying decreased despite more intensive care unit admissions. This is the first large-scale cohort study quantifying intensive care unit utilisation by head and neck cancer patients. It informs future work investigating alternatives to the intensive care unit for these patients.

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Section: Discussionmentioning

confidence: 93%

Outcomes for head and neck cancer patients admitted to intensive care in Australia and New Zealand between 2000 and 2016

et al. 2021

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“…A recent study by Barber et al 29 looked at the utility of a CCP for expediting transfer from the ICU to the ward in HNC with microvascular reconstruction. The authors similarly initiated spontaneous breathing trials in the OR, and most but not all patients were spontaneously breathing upon arrival to the ICU.…”

Section: Discussionmentioning

confidence: 99%

A Clinical Care Pathway to Reduce ICU Usage in Head and Neck Microvascular Reconstruction

Morse

Henderson

Carafeno

et al. 2018

Otolaryngol.--head neck surg.

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Objective To design and implement a postoperative clinical care pathway designed to reduce intensive care usage on length of stay, readmission rates, and surgical complications in head and neck free flap patients. Methods A postoperative clinical care pathway detailing timelines for patient care was developed by a multispecialty team. In total, 108 matched patients receiving free tissue transfer for reconstruction of head and neck defects in the year before (prepathway), year after (early pathway), and second year after (late pathway) pathway implementation were compared based on postoperative length of stay, 30-day readmission rate, intensive care unit (ICU) admission, and rates of medical/surgical complications. Results Median length of stay decreased from 10 to 7.5 and 7 days in the pre-, early, and late-pathway groups, respectively ( P = .012). Readmission rate decreased from 16% in the prepathway group to 0% and 3% in the early and late-pathway groups. The number of patients admitted to the ICU postoperatively decreased from 100% to 36% and 6% in the pre-, early, and late-pathway groups, respectively ( P = .025). The rates of surgical and medical complications were equivalent. Discussion This pathway effectively reduced ICU admission, length of stay, and readmission rates, without increasing postoperative complications. These outcomes were sustainable over 2 years. Implications for Practice Free flap patients may not require routine ICU admission and may be taken off ventilatory support in the operating room. This effectively reduces costly resource use in this patient population. Similar pathways could be introduced at other institutions.

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“…(Figure 1). [10][11][12][13][14][15][16][17][18] The most common reasons for exclusion were wrong outcomes and inappropriate study design. Among the studies, there were 5 prospective cohort studies, 2 cross-sectional studies, and 2 retrospective cohort studies (Table 2).…”

Section: Search Termsmentioning

confidence: 99%

Enhanced Recovery After Surgery Protocols for Head and Neck Cancer: Systematic Review and Meta‐analysis

Kattar

Wang

Trojan

et al. 2022

Otolaryngol.--head neck surg.

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Objective Enhanced recovery after surgery (ERAS) protocols aim to optimize the pre-, intra-, and postoperative care of patients to improve surgery outcomes, reduce complications, decrease length of stay, and more. We aim to perform a systematic review and meta-analysis of ERAS protocols for head and neck cancer surgery with or without microvascular reconstruction. Data Sources PubMed, Embase, and Web of Science databases were queried, and abstracts were screened independently by 2 investigators. Review Methods This review was conducted in accordance with the PRISMA guidelines. We included comparative observational studies but excluded animal studies, case reports, and case series. Results Of 557 articles initially reviewed by title and/or abstract, we identified 30 for full-text screening, and 9 met the criteria for qualitative synthesis. Meta-analysis of length of stay revealed a mean decrease of 1.37 days (95% CI, 0.77-1.96; I2 = 0%; P < .00001) with the ERAS group as compared with non-ERAS controls. The standardized mean difference of the morphine milligram equivalent was 0.72 lower (95% CI, 0.26-1.18; I2 = 82%; P = .002) in the ERAS group vs controls. The quality of studies was moderate with a median MINORS score of 18.5 (range, 13.5-21.5). Conclusion Implementation of ERAS protocols can lead to decreases in length of stay and opioid drug utilization. However, further high-quality prospective studies of ERAS protocols are needed, especially with stratified analysis of outcomes based on the type of head and neck cancer surgery.

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Efficacy of a high‐observation protocol in major head and neck cancer surgery: A prospective study

Abstract: Rapid weaning of sedation and limiting mechanical ventilation may contribute to a shorter length of ICU admission and LOS, as well as decreased ICU readmissions. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1689-1695, 2016.

Cited by 4 publications

References 20 publications

Outcomes for head and neck cancer patients admitted to intensive care in Australia and New Zealand between 2000 and 2016

Outcomes for head and neck cancer patients admitted to intensive care in Australia and New Zealand between 2000 and 2016

A Clinical Care Pathway to Reduce ICU Usage in Head and Neck Microvascular Reconstruction

Enhanced Recovery After Surgery Protocols for Head and Neck Cancer: Systematic Review and Meta‐analysis

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