The effectiveness of an enhanced recovery after surgery protocol in head and neck cancer surgery with free-flap reconstruction

Abstract

PurposeAn enhanced recovery after surgery (ERAS) protocol incorporates up-to-date perioperative care principles; the primary aim in using an ERAS protocol is to reduce issues that delay the recovery and cause the complications. The aim of this study was to compare outcomes associated with head and neck cancer surgery with free-flap reconstruction before and after implementation of an ERAS protocol.MethodsOutcomes were analyzed by dividing patients into 2 groups: 29 patients in the non-ERAS group and 60 patients in the ERAS group. The ERAS group performed a prospective observational cohort study of patients who underwent a head and neck cancer surgery with free-flap reconstruction in Ajou University Hospital from August 2015 to December 2017. The non-ERAS group retrospectively reviewed the medical records of patients who had undergone the same surgery from August 2012 to July 2015.ResultsDemographics, comorbidities, hospital length of stay (LOS), postoperative complications, starting time of rehabilitation, and postoperative periods before radiotherapy for the non-ERAS and ERAS groups were compared. Hospital LOS was significantly lower for patients whose care followed the ERAS protocol than for patients in the non-ERAS group (30.87 ± 20.72 days vs. 59.66 ± 40.43 days, P < 0.0001).ConclusionIn this study, hospital LOS was reduced through fast recovery after the implementation of the ERAS protocol. Therefore, the ERAS protocol appeared feasible and safe in head and neck cancer surgery with free-flap reconstruction.

The Use of Vasopressor Agents in Free Tissue Transfer for Head and Neck Reconstruction: Current Trends and Review of the Literature

“…Free tissue transfer for head and neck reconstruction often requires prolonged operative times and long hospitalizations ( Won et al, 2019 ). ERAS protocols specific to head and neck surgery have been proposed and implemented to help reduce surgical complications and enhance recovery by utilizing a multimodal and multidisciplinary approach ( Coyle et al, 2015 ; Dort et al, 2017 ).…”

Comparison Between the Impact of Vasopressors and Goal-Directed Fluid Therapy on the Management of Free Flap Reconstruction of Head and Neck and Monitoring in ICU

“…It is well known that head and neck free flap reconstruction requires long operative and hospitalization times [22]. Goal-directed fluid replacement (equal weight in the immediate pre-and postoperative period) is one of the protocols specific to head and neck surgery that was designed to optimize patients' cardiovascular performance and thus proposed to reduce surgical morbidities and reduce the length of stay by utilizing a multimodal and multidisciplinary algorithms [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21].…”

“…Postoperative variables are the duration of ICU hospitalization, 30-day flap survival and flap-related complications including flap dehiscence, fistula, donor site complications, need for reoperation due to flap failure [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30].…”

“…may suffer hypoperfusion (occult hypoperfusion). Consequently, controlling cardiac index remains the basis of goal-directed fluid replacement which can be achieved by functional hemodynamic monitoring [ 22 ]. Conferring to these data, surgical wound healing is associated with increased tissue oxygen consumption which necessitates an increase of the cardiac output and modulation of systemic vascular resistance in order to pass the perioperative period without organ failure [ 21 ].…”

“…In GDT, the intravenous fluids, vasopressors and inotropic administration are guided by instantaneous measurements of stroke volume (SV) and stroke volume variation (SVV) in one respiratory cycle to optimize cardiac output (CO). If hypovolemia occurs, the SVV will be exaggerated, with more response to fluid administration and better hemodynamic stability [ 22 ]. In order to perform GDT, the FloTrac/Vigileo system (Edwards Lifesciences LCC, Irvine, CA) is used for monitoring hemodynamic stability.…”