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

Abstract

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.

Malnutrition in Head and Neck Free Flap Reconstruction as a Predictor of Adverse Outcomes

“…Blood laboratory tests including values of C-reactive protein, albumin, prealbumin, and thyroid-stimulating hormone are assessed at least twice before the surgery date. Its extensive measures have shown significant reduction in hospital LOS in numerous studies, which is in alignment with our study's findings 32,34,35 …”

“…Its extensive measures have shown significant reduction in hospital LOS in numerous studies, which is in alignment with our study's findings. 32,34,35 Limitations of this study are consistent with those of a retrospective review. As the NSQIP database only includes select information from participating hospitals, it may not be representative of the general population and introduce selection bias.…”

Implementation and Outcomes of ERAS Protocol for Major Oncologic Head and Neck Surgery

“…The high level of interdepartmental coordination required for protocol adherence remains a challenge across surgical disciplines. [11][12][13][14][15] In 2015, Coyle et al described the process of developing and implementing an ERAS protocol for major head and neck surgery in a single healthcare system in the United Kingdom and reported variable levels of adherence across the protocol at one year. However, despite the challenges with design and implementation of ERAS protocols, the reported benefits to patients and institutions suggest a potential worthwhile investment.…”

“…However, protocol development and implementation have been described in pediatric surgery, gynecologic oncology, and cardiac surgery. The high level of interdepartmental coordination required for protocol adherence remains a challenge across surgical disciplines 11–15 . In 2015, Coyle et al described the process of developing and implementing an ERAS protocol for major head and neck surgery in a single healthcare system in the United Kingdom and reported variable levels of adherence across the protocol at one year.…”

IAPEN INDIA Consensus Statement on Nutritional Management in Head and Neck Cancers

“…(94) HNC patients can benefit from comprehensive ERAS protocols, by helping them enhance their recovery, including breathing, food intake, pain, speech, swallowing, and communication. (98) Prolonged inadequate oral intake is associated with higher mortality.…”