Enhanced recovery after surgery (ERAS) strategies: possible advantages also for head and neck surgery patients?

Abstract

Enhanced recovery after surgery (ERAS) programs have recently been developed in order to reduce morbidity, improve recovery, and shorten hospital stays of surgical patients. Since the 1990 s, ERAS programs have been successfully applied in many centres, especially in northern Europe and America, to perioperative management for colorectal surgery, vascular surgery, thoracic surgery, and then also to urological and gynaecologic surgery. Purpose of this paper is to evaluate and discuss the very recent introduction of ERAS programs also in head and neck surgery. Embase and Pubmed database searches were performed for relevant published studies. There are still no reports concerning the results of the application of ERAS protocols in the head and neck field. ERAS programs, however, could offer also to head and neck surgery patients an advantage in terms of fastening recovery, reducing hospital stay, and favouring early return to daily activities after hospital discharge. Therefore, the investigation of specific ERAS protocol in head and neck surgery patients should be encouraged.

A call for new standard of care in perioperative gynecologic oncology practice: Impact of enhanced recovery after surgery (ERAS) programs

“…The most important tools implemented in ERAS programs in colorectal surgery are regional analgesia; enforced early mobilization and enteral nutrition; avoidance of mechanical bowel preparation, tubes, drains, or catheters; and use of minimally invasive surgery. Similar programs are currently being implemented and studied in other disciplines of surgery, such as orthopedic, gynecologic, vascular, and other types of abdominal surgery [16–18]. …”

Intraoperative goal‐directed hemodynamic management in free tissue transfer for head and neck cancer

“…At the time of writing this manuscript, there are 2 additional clinical trials registered on ClinicalTrials.gov examining the safety and efficacy of similar protocols on microvascular FTT, demonstrating the momentum that is building to update the perioperative hemodynamic management of this patient population. In fact, a recent review called upon the medical profession to collaborate and apply “enhanced recovery after surgery” protocols to the head and neck surgical population; of note, a major component of these protocols is goal‐directed fluid and vasopressor administration …”

Hospital stay following complex major head and neck resection: what factors play a role?

“…ERAS protocols have been successfully employed in various fields of surgery with significant reductions in LOS being demonstrated, especially in colorectal surgery . There is currently no robust data to support the use of ERAS programmes in head and neck cancer surgery, but the implementation of these protocols should be explored further to expedite postoperative recovery and hospital discharge …”

“…17 There is currently no robust data to support the use of ERAS programmes in head and neck cancer surgery, but the implementation of these protocols should be explored further to expedite postoperative recovery and hospital discharge. 18 The preoperative and postoperative submodels also increase the availability of predictive tools and allow clinicians and managers to estimate the likely LOS and bed status, thereby help determine the availability of beds so that the admission of future patients can be planned accordingly. In addition, these submodels can also plan the usage of hospital resources and calculate tariffs.…”