Enhanced recovery and medical management after head and neck microvascular reconstruction

Abstract

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.