Enhanced recovery after surgery program involving preoperative dexamethasone administration for head and neck surgery with free tissue transfer reconstruction: Single-center prospective observational study

Imai, Takayuki; Kurosawa, Koreyuki; Asada, Yukinori; Momma, Yumiko; Takahashi, Maki; Satake, Naoko; Azuma, Misato; Suzuki, Ai; Sasaki, Megumi; Morita, Shinkichi; Saijo, Satoshi; Fujii, Keitaro; Kishimoto, Kazuto; Yamazaki, Tomoko; Goto, Takahiro; Matsuura, Kazuto

doi:10.1016/j.suronc.2020.04.025

Cited by 22 publications

(22 citation statements)

References 44 publications

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“…Using data from a large cohort of 445 patients collected over the past eight years, we found that the overall proportion of patients mobilized within 24 h was 44%, and 77% were moving by POD 2. Our study extends the work of others on compliance with ERAS early mobilization targets after HNC surgery [21][22][23][24][25]. In 2016, motivated by data showing suboptimal mobilization performance, our pathway target was adjusted with beneficial results.…”

Section: Discussionmentioning

confidence: 59%

“…Avoiding bed rest, preventing functional decline and progressing towards preoperative activity levels helps patients meet discharge criteria earlier and sets the stage for a seamless transition to recovery at home. ERAS pathways for HNC surgery have begun to measure step counts objectively using pedometers [25], and commercially-available wearable technology offers a more sophisticated solution that could be integrated within the EMR. An objective measure of mobilization would improve understanding of the dose-response relationship: the quantity of mobilization (e.g., number of daily step counts) that is safe and associated with improved patient outcomes [30].…”

Section: Discussionmentioning

confidence: 99%

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Impact of Early Mobilization on Recovery after Major Head and Neck Surgery with Free Flap Reconstruction

Twomey

Matthews

Nakoneshny

et al. 2021

Cancers

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Surgery with free flap reconstruction is a standard treatment for head and neck cancer (HNC). Because of the complexity of HNC surgery, recovery can be challenging, and complications are common. One of the foundations of enhanced recovery after surgery (ERAS) is early postoperative mobilization. The ERAS guidelines for HNC surgery with free flap reconstruction recommend mobilization within 24 h. This is based mainly on evidence from other surgical disciplines, and the extent to which mobilization within 24 h improves recovery after HNC surgery has not been explored. This retrospective analysis included 445 patients from the Calgary Head and Neck Enhanced Recovery Program. Mobilization after 24 h was associated with more complications of any type (OR = 1.73, 95% CI [confidence interval] = 1.16–2.57) and more major complications (OR = 1.76; 95% CI = 1.00–3.16). When accounting for patient and clinical factors, mobilization after 48 h was a significant predictor of major complications (OR = 2.61; 95% CI = 1.10–6.21) and prolonged length of stay (>10 days; OR = 2.85, 95% CI = 1.41–5.76). This comprehensive analysis of the impact of early mobilization on postoperative complications and length of stay in a large HNC cohort provides novel evidence supporting adherence to the ERAS early mobilization recommendations. Early mobilization should be a priority for patients undergoing HNC surgery with free flap reconstruction.

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Impact of Early Mobilization on Recovery after Major Head and Neck Surgery with Free Flap Reconstruction

Twomey

Matthews

Nakoneshny

et al. 2021

Cancers

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“…A substantial number of practical improvements were made over the past years regarding surgical care. Besides the progress of minimally-invasive surgery, robotics and ≪ augmented ≫ surgery [58], the implementation of Enhanced Recovery After Surgery (ERAS) protocols [59][60][61] represents a significant attempt to modernize surgical procedures. The ERAS protocols constitute a collection of supportive measures that aim to reduce some of the complications and negative effects of surgery, such as surgical stress.…”

Section: Studying the Perioperative Window For The Development Of Better Therapeutics Against Osccmentioning

confidence: 99%

“…Importantly, ERAS protocols aim to reduce the early complications of surgery and facilitate the patient's discharge. There is currently no evidence that the application of ERAS protocols can favorably impact the oncological prognosis of OSCC, despite their positive effects on a number of blood markers (CRP, albumin and neutrophil-to-lymphocyte ratio) [ 60 ]. This will be an important aim for future studies.…”

Section: Studying the Perioperative Window For The Development Of Better Therapeutics Against Osccmentioning

confidence: 99%

Therapeutic Perspectives for the Perioperative Period in Oral Squamous Cell Carcinoma (OSCC)

Galmiche¹,

Saidak²,

Bettoni³

et al. 2022

Front. Oral. Health

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The perioperative period is the relatively short window of time, usually measured in days or weeks, around the surgical procedure. Despite its short duration, this time period is of great importance for cancer patients. From a biological point of view, the perioperative period is complex. Synchronous with primary tumor removal, surgery has local and distant consequences, including systemic and local inflammation, coagulation and sympathetic activation. Furthermore, the patients often present comorbidities and receive several medical prescriptions (hypnotics, pain killers, anti-emetics, hemostatics, inotropes, antibiotics). Because of the complex nature of the perioperative period, it is often difficult to predict the oncological outcome of tumor resection. Here, we review the biological consequences of surgery of Oral Squamous Cell Carcinoma (OSCC), the most frequent form of primary head and neck tumors. We briefly address the specificities and the challenges of the surgical care of these tumors and highlight the biological and clinical studies that offer insight into the perioperative period. The recent trials examining neoadjuvant immunotherapy for OSCC illustrate the therapeutic opportunities offered by the perioperative period.

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“…Enhanced recovery after surgery (ERAS) is a multidisciplinary collaborative approach that seeks to expedite patient recovery by minimizing postoperative stress and complication rates. ERAS approaches have improved outcomes associated with colorectal surgery 3 , and are also commonly employed in the context of gynecological, urological, cardiothoracic surgeries and head&neck surgery [4][5][6][7] .…”

Section: Introductionmentioning

confidence: 99%

Individualized Enhanced recovery after surgery (ERAS) protocols for patients with hepatocellular carcinoma: a retrospective study

Zhang

Cheng

Zhang

et al. 2022

Preprint

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Background:Hepatocellular carcinoma (HCC) patients often undergo curative liver resection to treat this form of cancer. Hepatectomy is, however, a form of major surgery associated with many significant risks including prolonged hospitalization, high costs, impaired physiological function, and high postoperative complication rates. Enhanced recovery after surgery (ERAS) is a multidisciplinary approach that seeks to expedite postoperative recovery in patients undergoing major surgeries in order to lower postoperative complication rates. Prior studies have successfully employed ERAS approaches in the context of gynecological, urological, and cardiovascular surgeries. However, HCC is a complex disease and affected patients may also suffer from pre-existing liver disease, making it essential that they be administered appropriate individually tailored treatments. This study was thus designed to assess the efficacy and safety of individualized ERAS approaches in patients undergoing hepatectomy. Methods:In total, we retrospectively analyzed data from 90 HCC patients that underwent hepatectomy between October 2018 and August 2019. All patients met the study enrollment criteria and provided written informed consent to participate. All studies were approved by the Hospital Research Ethics Committee and were consistent with the Declaration of Helsinki. Patients were randomly divided into two groups (n=45 each) based on the employed perioperative treatment strategies: a conventional treatment group and an ERAS treatment group. Key outcomes were then compared between groups, including postoperative pain scores, duration of postoperative hospitalization, medical costs, and rates of readmission. Quantitative data are given as `x±s and were compared via Student’s t-tests, whereas categorical data were compared via chi-squared tests and Fisher's exact test.Results:ERAS treatment was associated with lower postoperative pain scores at 24, 48, and 72 h post-treatment (P<0.05), with a shorter postoperative hospitalization duration (8.16 days vs.10.49 days; P<0.004), and with lower medical costs (P<0.004) as compared to traditional treatment. No significant differences in complication rates (P>0.05) or readmission rates (P>0.557) were observed between these groups. Conclusions:Individualized ERAS improves patient postoperative recovery more effectively than traditional treatment in patients undergoing hepatectomy.

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Enhanced recovery after surgery program involving preoperative dexamethasone administration for head and neck surgery with free tissue transfer reconstruction: Single-center prospective observational study

Cited by 22 publications

References 44 publications

Impact of Early Mobilization on Recovery after Major Head and Neck Surgery with Free Flap Reconstruction

Impact of Early Mobilization on Recovery after Major Head and Neck Surgery with Free Flap Reconstruction

Therapeutic Perspectives for the Perioperative Period in Oral Squamous Cell Carcinoma (OSCC)

Individualized Enhanced recovery after surgery (ERAS) protocols for patients with hepatocellular carcinoma: a retrospective study

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