Enhanced Recovery After Surgery (ERAS) in Head and Neck Oncologic Surgery: A Case-Matched Analysis of Perioperative and Pain Outcomes

Kiong, Kimberley L.; Vu, Catherine N.; Yao, Christopher M. K. L.; Kruse, Brittany; Zheng, Gang; Yu, Peirong; Weber, Randal S.; Lewis, Carol M.

doi:10.1245/s10434-020-09174-2

Cited by 26 publications

(54 citation statements)

References 34 publications

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“…Taken together, the published literature supporting ERAS protocols strongly suggests their efficacy in a variety of surgical fields. Head and neck oncologic patients stand to uniquely benefit from such centralized, multidisciplinary protocols 14–17 . These patients have a variety of needs given the complexity of their surgical and medical care, which may affect multiple facets of their recovery, including breathing, eating, nutrition, pain, speech, swallowing, and communication.…”

Section: Introductionmentioning

confidence: 99%

Implementation of an enhanced recovery after surgery protocol for head and neck cancer patients: Considerations and best practices

Prasad

Chorath

Barrette

et al. 2022

World j. otorhinolaryngol.-head neck surg.

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Enhanced recovery after surgery (ERAS) protocols have been developed in numerous surgical specialties as a means of systematically improving patient recovery, functional outcomes, cost savings, and resource utilization. Such multidisciplinary initiatives seek to minimize variability in several aspects of perioperative patient care, helping to reduce inpatient length of hospital stay, complications, and the overall resource and financial burden of surgical care. Head and neck oncology patients stand to benefit from the implementation of comprehensive ERAS protocols, as these patients have complex medical needs that may dramatically impact multiple aspects of their recovery, including breathing, eating, nutrition, pain, speech, swallowing, and communication. Implementing ERAS protocols for head and neck cancer patients may present unique challenges, and require significant interdisciplinary coordination and collaboration. We therefore sought to provide a comprehensive guide to the planning and institution of such ERAS systems at institutions undertaking care of head and neck cancer patients. Key elements to consider in the implementation of successful ERAS protocols for this population include organizing a team consisting of frontline leaders such as nursing staff, medical specialists, and associated health professionals; designing interventions based on systematically evaluated, high‐quality literature; and instituting a clear methodology for regularly updating protocols and auditing the success or potential limitations of a given intervention. Potential obstacles to the success of ERAS interventions for head and neck cancer patients include challenges in systematically tracking progress of the protocol, as well as resource limitations in a given health system.

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Section: Introductionmentioning

confidence: 99%

Implementation of an enhanced recovery after surgery protocol for head and neck cancer patients: Considerations and best practices

Prasad

Chorath

Barrette

et al. 2022

World j. otorhinolaryngol.-head neck surg.

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show abstract

“…While the composition of interventions comprising an ERAS protocol has differed amongst the many head and neck institutions reporting results of their ERAS implementation, the results of these implementations are often similar. In particular, implementation studies have demonstrated that, compared to control groups treated with conventional perioperative care, ERAS patient cohorts experience reduced ICU and hospital stays, reduced delay between surgery and adjuvant radiotherapy, diminished narcotic use in the first 24-72 h after surgery, and fewer overall complications [13][14][15][16] .…”

Section: Eras For Major Head and Neck Surgerymentioning

confidence: 99%

“…The use of multimodal analgesia in the postoperative setting has been shown to reduce overall opioid use and expedite recovery [12,[90][91][92] . Pain regimens consisting of multiple opioid-sparing analgesics, such as gabapentin, acetaminophen, and non-steroidal anti-inflammatory drugs (NSAIDs), have demonstrated synergistic effects and enable the reservation of opioids for breakthrough pain alone [13] . Gabapentin, in particular, appears to provide a significant ameliorative effect on postoperative pain and analgesic consumption when administered preoperatively and continued in the postoperative setting [93,94] .…”

Section: Pain Managementmentioning

confidence: 99%

Enhanced recovery and medical management after head and neck microvascular reconstruction

Gidumal¹,

Worrall²,

Phan³

et al. 2021

PAR

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Protocols to enhance and expedite recovery after surgery originally developed through efforts in gastrointestinal, colorectal, and thoracic surgery populations. Implementation of specific evidence-based interventions undertaken in the perioperative setting has been shown to decrease the length of stay, reduce cost, and improve patient outcomes and satisfaction. The basic tenets of enhanced recovery protocols are to reduce physiologic stress in the perioperative setting, improve nutritional status before and after surgery, promote respiratory and physical rehabilitation, and encourage frequent and recurring reassessment for quality improvement. Some interventions, such as the use of deep vein thrombosis prophylaxis in the perioperative setting, are now well established across surgical populations; however, the increased attention to these protocols has led to new innovative interventions in the head and neck population. This review highlights these innovative interventions designed to enhance recovery after major surgery, lends particular focus to the biological mechanisms behind these interventions, and describes their relevance to the head and neck population.

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“…A significant reduction in morphine milligram equivalents (MMEs) required over 72 h was seen in the ERAS group (138.8 ± 181.5 vs. 207.9 ± 205.5; p \ 0.001). 12 This study represents a key addition to the ERAS literature in general and sets the standard for perioperative management for major head and neck surgery requiring free-flap reconstruction. The HNRS-ERAS pathway described should become a cornerstone of managing these complex patients.…”

mentioning

confidence: 99%

“…In this issue of Annals of Surgical Oncology, Kiong et al use this comprehensive Head and Neck/Reconstructive Surgery ERAS (HNRS-ERAS) pathway and narrow the definition of major head and neck surgery to oncologic surgeries requiring microvascular free-flap reconstruction, since these procedures are complex, involve significant blood loss and postoperative pain, as well as lengthy hospital stays and complex multidisciplinary rehabilitation. 12 The investigators conducted a case-matched cohort study using the HNRS-ERAS pathway to intervene and track outcomes based on the principles of patient education, goal-directed fluid management, multimodal analgesia, and early mobilization. The outcomes tracked were based on the HNRS National Surgical Quality Improvement Program (NSQIP) database.…”

mentioning

confidence: 99%

Editorial Comment on “Enhanced Recovery After Surgery (ERAS) in Head and Neck Oncologic Surgery: A Case-Matched Analysis of Perioperative and Pain Outcomes”

Chen

Sumer

2020

Ann Surg Oncol

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Enhanced Recovery After Surgery (ERAS) in Head and Neck Oncologic Surgery: A Case-Matched Analysis of Perioperative and Pain Outcomes

Cited by 26 publications

References 34 publications

Implementation of an enhanced recovery after surgery protocol for head and neck cancer patients: Considerations and best practices

Implementation of an enhanced recovery after surgery protocol for head and neck cancer patients: Considerations and best practices

Enhanced recovery and medical management after head and neck microvascular reconstruction

Editorial Comment on “Enhanced Recovery After Surgery (ERAS) in Head and Neck Oncologic Surgery: A Case-Matched Analysis of Perioperative and Pain Outcomes”

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