Enhanced recovery in patients having free tissue transfer for head and neck cancer: does it make a difference?

Bater, M.; King, Wendy; Teare, Julian; D'Souza, Jacob

doi:10.1016/j.bjoms.2017.10.012

Cited by 41 publications

(41 citation statements)

References 17 publications

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“…A systematic review of head and neck care pathways showed encouraging results but very high study heterogeneity precluded strong recommendations for pathway use [20]. Recent work using an enhanced recovery after surgery (ERAS) protocol for patients undergoing resection with free flap reconstruction found reductions in LOS but no differences in complications among ERAS managed patients [21].…”

Section: Discussionmentioning

confidence: 99%

The impact of a quality management program for patients undergoing head and neck resection with free-flap reconstruction: Longitudinal study examining sustainability

Dort

Sauro

Chandarana

et al. 2020

Journal of Otolaryngology - Head & Neck Surgery

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Background: Care pathways (CPs) are helpful in reducing unwanted variation in clinical care. Most studies of CPs show they improve clinical outcomes but there is little known about the long-term impact of CPs as part of a sustained quality management program. Head and neck (HN) surgery with free flap reconstruction is complex, time-consuming and expensive. Complications are common and therefore CPs applied to this patient population are the focus of this paper. In this paper we report outcomes from a 9 year experience designing and using CPs in the management of patients undergoing major head and neck resection with free flap reconstruction. Methods: The Calgary quality management program and CP design is described the accompanying article. Data from CP managed patients undergoing major HN surgery were prospectively collected and compared to a baseline cohort of patients managed with standard care. Data were retrospectively analyzed and intergroup comparisons were made. Results: Mobilization, decannulation time and hospital length of stay were significantly improved in pathwaymanaged patients (p = 0.001). Trend analysis showed sustained improvement in key performance indicators including complications. Return to the OR, primarily to assess a compromised flap, is increasing. Conclusions: Care pathways when deployed as part of an ongoing quality management program are associated with improved clinical outcomes in this complex group of patients.

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Section: Discussionmentioning

confidence: 99%

The impact of a quality management program for patients undergoing head and neck resection with free-flap reconstruction: Longitudinal study examining sustainability

Dort

Sauro

Chandarana

et al. 2020

Journal of Otolaryngology - Head & Neck Surgery

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“…[ 12 ] The readmission was the rate of second hospital admission after 30 days. [ 13 , 14 ] The basic demographic and clinical differences were also measured.…”

Section: Methodsmentioning

confidence: 99%

Cost-benefit analysis of enhanced recovery after hepatectomy in Chinese Han population

et al. 2018

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Background:Enhanced recovery after surgery (ERAS) programs have been proved effective for enhancing the clinical healing rate and reducing hospitalization cost in most countries of the world. It's a multi-model approach that designed to optimize perioperative pathway, attenuate the surgical stress response, and decrease postoperative complications.Objective:The economic benefit from the application of ERAS to colorectal surgery has been demonstrated in China. However, such economic benefit of ERAS programs for hepatectomy hasn’t been clarified yet. This study was carried out to explore the clinical efficacy and cost effectiveness of ERAS in Chinese Han population after hepatectomy.Methods:ERAS program was implemented in our department for hepatectomy in December 2016. In total, 79 consecutive patients after hepatectomy were chosen as ERAS group (ERAS protocol) in coming half year while 121 consecutive patients after hepatectomy were chosen as Pre-ERAS group (traditional protocol) in past half year. The operation time, intraoperative blood loss, length of hospital stay (LOS), complication, readmission, and hospitalization cost of 2 groups were compared.Results:The LOS of ERAS group was 5.81 ± 1.79 days, significantly shorter than that of Pre-ERAS group (8.06 ± 3.40 d) (P = .000). The operation time was 168.03 ± 46.20 minutes for ERAS group and 175.41 ± 64.64 minutes for Pre-ERAS group respectively (P = .417). The intraoperative blood loss was 166.58 ± 194.13 mL (ERAS group) and 205.45 ± 279.63 mL (Pre-ERAS group) (P = .293). It should be noted that the hospitalization cost of ERAS group was 51556.18 ± 8926.05 Yuan (7835.05 ± 1355.45 US dollars), significantly less than that of Pre-ERAS group 60554.66 ± 15615.31 Yuan (9202.56 ± 2371.24 US dollars) (P = .000). The application of ERAS effectively saved 8998.48 Yuan (1367.51 US dollars) for each patient.Conclusions:ERAS implementation for hepatectomy surgery is safe and feasible for Chinese Han population. It eventually enhanced the clinical healing rate. The benefits from such programs include a reduction of the LOS, complication, and readmission rates. So each patient has access to better medical service. It effectively relieved the financial burden of patients. The benefits from such programs include a reduction of the hospitalization cost, especially in medication cost. So each patient can afford the diseases.

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“…This allows it to be responsive to changes in clinical outcomes as well as new evidence. For example, recent work using an enhanced recovery after surgery (ERAS) protocol for patients undergoing resection with free flap reconstruction, which have been found to reduce hospital LOS [26] to be integrated. Conversely, the current care pathway reported in this study has some significant gaps.…”

Section: Discussionmentioning

confidence: 99%

Designing and integrating a quality management program for patients undergoing head and neck resection with free-flap reconstruction

Dort

Sauro

Schrag

et al. 2020

Journal of Otolaryngology - Head & Neck Surgery

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Background: Care pathways (CPs) offer a proven method of systematically improving patient care. CPs are particularly helpful in complex clinical conditions where variation in care is a problem such as patients undergoing major head and neck resection with free flap reconstruction. Although CPs have been used to manage this patient group, most CPs are implemented as part of relatively short-term quality improvement projects. This paper outlines a detailed methodology for designing and delivering a quality management program sustained for 9 years. Methods: We describe a change management approach informed by Kotter's "8 Step Process" that provided a useful framework to guide program development and implementation. We then provide a detailed, step by step description of how such a program can be implemented as well as a detailed summary of time and costs for design, implementation and sustainability phases. An approach to design and delivery of a measurement, audit and feedback system is also provided. Results: We present a summary of resources needed to design and implement a head and neck surgery quality management program. The primary result of this study is a design for a sustainable quality management program that can be used to guide and improve care for patients undergoing major head and neck resection with free flap reconstruction. Conclusions: A change management approach to design and delivery of a head and neck quality management program is practical and feasible.

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Enhanced recovery in patients having free tissue transfer for head and neck cancer: does it make a difference?

Cited by 41 publications

References 17 publications

The impact of a quality management program for patients undergoing head and neck resection with free-flap reconstruction: Longitudinal study examining sustainability

The impact of a quality management program for patients undergoing head and neck resection with free-flap reconstruction: Longitudinal study examining sustainability

Cost-benefit analysis of enhanced recovery after hepatectomy in Chinese Han population

Designing and integrating a quality management program for patients undergoing head and neck resection with free-flap reconstruction

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