Enhanced Recovery after Surgery (ERAS) protocols in craniomaxillofacial surgery: an evidence-based review

Abstract

Purpose of review Enhanced Recovery after Surgery (ERAS) refers to a patient centered, multidisciplinary team developed pathway aimed at reducing the surgical stress response and facilitating expedited patient postoperative recovery. These protocols have been largely developed in the general surgery literature and have led to vast improvements in the patient experience. With a growing shortage of hospital resources during the height of the COVID-19 pandemic there has been a growing push to apply these principles to a wide variety of specialties. Recent findings ERAS protocols are generally substantiated on three phases along the continuum of surgical care: preadmission optimization, intraoperative treatment, and postoperative management. In this article, the evidence for ERAS development in craniomaxillofacial surgery will be reviewed, and recommendations from prior studies for enhanced recovery will be outlined. Summary ERAS protocols have been proven effective in many surgical arenas, however, modification is needed for the craniomaxillofacial population. The implications for widespread implementation of ERAS protocols during these procedures are a potentially shortened length of stay, expedited early return to function, reduction in narcotic dependence, and reduction in postdischarge complications necessitating additional intervention.

Opioid Sparing by ERAS Protocol in Cleft Lip and Palate Craniofacial Surgery

“…2 More recently, ERAS protocols for cleft lip repair have been proven to reduce opioid use, leading to shortened time to feeding resumption and return to function. 14,16,22…”

“…2 More recently, ERAS protocols for cleft lip repair have been proven to reduce opioid use, leading to shortened time to feeding resumption and return to function. 14,16,22 Our study sought to identify the benefits that an ERAS protocol with oral acetaminophen had in the immediate 2 years following its implementation compared to the 2 years prior. By implementing ERAS, an expected rise in both IV and PO NSAID utilization for pain management was witnessed during the patient's hospital course.…”