Enhanced recovery after surgery (ERAS) for head and neck oncology patients

Abstract

The ERAS programme developed is now embedded in the care pathway for people undergoing head and neck cancer surgery in our unit. The mean length of hospital stay has reduced since the introduction of the programme.

Tracheostomy or delayed extubation after maxillofacial free-flap reconstruction?

“…5,[9][10][11] Restricting the use of tracheostomy to selected cases has also become an important part of some ERAS (enhanced recovery after surgery) programmes. 12 patients who have had a tracheostomy and those who have not because of the diverse range of coexisting conditions and the different operations. 10,13 At the Oral and Maxillofacial Surgery (OMFS) Unit at St George's Hospital, London, UK, tracheostomy is done only in selected patients who have free-flap reconstruction.…”

Efficacy of Overnight Intubation in Oral Oncological Surgeries: A Retrospective Study

“…Tracheostomy related complications are not uncommon. 2,[5][6][7][8][9][10] Chest infections being the most common among all. 12 It is a source of anxiety to patients and agony to their relatives or bystanders and stands to be potentially life-threatening, as well.…”

“…Recently, as a part of the enhanced recovery after surgery (ERAS) programs, restricting the use of tracheostomy to selected cases have been emphasized. 9 Therefore, the practitioners choose alternative modalities like submental intubation to prevent the untoward complications. However, literature support on an alternative to tracheostomy for oral oncologic cases is limited.…”

A stratified analysis of the perioperative outcome of 17623 patients undergoing major head and neck cancer surgery in England over 10 years: Towards an Informatics‐based Outcomes Surveillance Framework

“…Caring for patients with head and neck cancer is dependent on consistent delivery of meticulous perioperative care. In recent years there has been a welcome emphasis towards improving the surgical outcome of patients with this condition and the principles of Enhanced Recovery After Surgery (ERAS) are being adapted to benefit the head and neck cancer patient . Benchmarking and improving the quality of surgical care in this context is predicated on near‐complete case accrual into a dataset which contains clinically relevant stratification and outcome variables .…”

“…It is logical that efforts to recognise and refer patients before airway obstruction, and improved pre‐habilitation of patients who present as emergencies prior to major surgery may play a role in improving the outcome but the impact of such interventions need to be systematically studied. Performing a tracheostomy is recognised as a deleterious risk‐factor and one of the objectives of head and neck enhanced recovery is to reduce the number of tracheostomies performed . The picture with flap‐based reconstruction is less clear.…”