ERAS for Head and Neck Tissue Transfer Reduces Opioid Usage, Peak Pain Scores, and Blood Utilization
Bhavishya S. Clark MD
Department of Otolaryngology – Head and Neck Surgery, Keck School of Medicine of USC, Los Angeles, California, U.S.A.
Search for more papers by this authorMark Swanson MD
Department of Otolaryngology – Head and Neck Surgery, Keck School of Medicine of USC, Los Angeles, California, U.S.A.
Search for more papers by this authorWilliam Widjaja BS
Department of Anesthesiology, Keck School of Medicine of USC, Los Angeles, California, U.S.A.
Search for more papers by this authorBrian Cameron BA
USC Keck School of Medicine, Los Angeles, California, U.S.A.
Search for more papers by this authorValerie Yu BS
Department of Anesthesiology, Keck School of Medicine of USC, Los Angeles, California, U.S.A.
Search for more papers by this authorKsenia Ershova MS, MD
Department of Anesthesiology, Keck School of Medicine of USC, Los Angeles, California, U.S.A.
Search for more papers by this authorFranklin M. Wu BA
USC Keck School of Medicine, Los Angeles, California, U.S.A.
Search for more papers by this authorErik B. Vanstrum BA
USC Keck School of Medicine, Los Angeles, California, U.S.A.
Search for more papers by this authorRuben Ulloa BA
USC Keck School of Medicine, Los Angeles, California, U.S.A.
Search for more papers by this authorAndrew Heng BS
USC Keck School of Medicine, Los Angeles, California, U.S.A.
Search for more papers by this authorMargaret Nurimba BS
USC Keck School of Medicine, Los Angeles, California, U.S.A.
Search for more papers by this authorNiels Kokot MD
Department of Otolaryngology – Head and Neck Surgery, Keck School of Medicine of USC, Los Angeles, California, U.S.A.
Search for more papers by this authorAmit Kochhar MD
Department of Otolaryngology – Head and Neck Surgery, Keck School of Medicine of USC, Los Angeles, California, U.S.A.
Search for more papers by this authorUttam K. Sinha MD
Department of Otolaryngology – Head and Neck Surgery, Keck School of Medicine of USC, Los Angeles, California, U.S.A.
Search for more papers by this authorM. P. Kim DO
Department of Anesthesiology, Keck School of Medicine of USC, Los Angeles, California, U.S.A.
Search for more papers by this authorCorresponding Author
Shane Dickerson MD
Department of Anesthesiology, Mount Sinai Hospital, New York, New York, U.S.A.
Send correspondence to Shane Dickerson, MD, Department of Anesthesiology, Mount Sinai Hospital, 1 Gustave L. Levy Place, Box 1010, New York, NY 10029. Email: [email protected]Search for more papers by this authorBhavishya S. Clark MD
Department of Otolaryngology – Head and Neck Surgery, Keck School of Medicine of USC, Los Angeles, California, U.S.A.
Search for more papers by this authorMark Swanson MD
Department of Otolaryngology – Head and Neck Surgery, Keck School of Medicine of USC, Los Angeles, California, U.S.A.
Search for more papers by this authorWilliam Widjaja BS
Department of Anesthesiology, Keck School of Medicine of USC, Los Angeles, California, U.S.A.
Search for more papers by this authorBrian Cameron BA
USC Keck School of Medicine, Los Angeles, California, U.S.A.
Search for more papers by this authorValerie Yu BS
Department of Anesthesiology, Keck School of Medicine of USC, Los Angeles, California, U.S.A.
Search for more papers by this authorKsenia Ershova MS, MD
Department of Anesthesiology, Keck School of Medicine of USC, Los Angeles, California, U.S.A.
Search for more papers by this authorFranklin M. Wu BA
USC Keck School of Medicine, Los Angeles, California, U.S.A.
Search for more papers by this authorErik B. Vanstrum BA
USC Keck School of Medicine, Los Angeles, California, U.S.A.
Search for more papers by this authorRuben Ulloa BA
USC Keck School of Medicine, Los Angeles, California, U.S.A.
Search for more papers by this authorAndrew Heng BS
USC Keck School of Medicine, Los Angeles, California, U.S.A.
Search for more papers by this authorMargaret Nurimba BS
USC Keck School of Medicine, Los Angeles, California, U.S.A.
Search for more papers by this authorNiels Kokot MD
Department of Otolaryngology – Head and Neck Surgery, Keck School of Medicine of USC, Los Angeles, California, U.S.A.
Search for more papers by this authorAmit Kochhar MD
Department of Otolaryngology – Head and Neck Surgery, Keck School of Medicine of USC, Los Angeles, California, U.S.A.
Search for more papers by this authorUttam K. Sinha MD
Department of Otolaryngology – Head and Neck Surgery, Keck School of Medicine of USC, Los Angeles, California, U.S.A.
Search for more papers by this authorM. P. Kim DO
Department of Anesthesiology, Keck School of Medicine of USC, Los Angeles, California, U.S.A.
Search for more papers by this authorCorresponding Author
Shane Dickerson MD
Department of Anesthesiology, Mount Sinai Hospital, New York, New York, U.S.A.
Send correspondence to Shane Dickerson, MD, Department of Anesthesiology, Mount Sinai Hospital, 1 Gustave L. Levy Place, Box 1010, New York, NY 10029. Email: [email protected]Search for more papers by this authorEditor's Note: This Manuscript was accepted for publication on May 5, 2020.
The authors have no funding, financial relationships, or conflicts of interest to disclose.
Abstract
Objectives
We implement a novel enhanced recovery after surgery (ERAS) protocol with pre-operative non-opioid loading, total intravenous anesthesia, multimodal peri-operative analgesia, and restricted red blood cell (pRBC) transfusions. 1) Compare differences in mean postoperative peak pain scores, opioid usage, and pRBC transfusions. 2) Examine changes in overall length of stay (LOS), intensive care unit LOS, complications, and 30-day readmissions.
Methods
Retrospective cohort study comparing 132 ERAS vs. 66 non-ERAS patients after HNC tissue transfer reconstruction. Data was collected in a double-blind fashion by two teams.
Results
Mean postoperative peak pain scores were lower in the ERAS group up to postoperative day (POD) 2. POD0: 4.6 ± 3.6 vs. 6.5 ± 3.5; P = .004) (POD1: 5.2 ± 3.5 vs. 7.3 ± 2.3; P = .002) (POD2: 4.1 ± 3.5 vs. 6.6 ± 2.8; P = .000). Opioid utilization, converted into morphine milligram equivalents, was decreased in the ERAS group (POD0: 6.0 ± 9.8 vs. 10.3 ± 10.8; P = .010) (POD1: 14.1 ± 22.1 vs. 34.2 ± 23.2; P = .000) (POD2: 11.4 ± 19.7 vs. 37.6 ± 31.7; P = .000) (POD3: 13.7 ± 20.5 vs. 37.9 ± 42.3; P = .000) (POD4: 11.7 ± 17.9 vs. 36.2 ± 39.2; P = .000) (POD5: 10.3 ± 17.9 vs. 35.4 ± 45.6; P = .000). Mean pRBC transfusion rate was lower in ERAS patients (2.1 vs. 3.1 units, P = .017). There were no differences between ERAS and non-ERAS patients in hospital LOS, ICU LOS, complication rates, and 30-day readmissions.
Conclusion
Our ERAS pathway reduced postoperative pain, opioid usage, and pRBC transfusions after HNC reconstruction. These benefits were obtained without an increase in hospital or ICU LOS, complications, or readmission rates.
Level of Evidence
3 Laryngoscope, 131:E792–E799, 2021
Supporting Information
| Filename | Description |
|---|---|
| lary28768-sup-0001-AppendixS1.pdfPDF document, 421 KB | APPENDIX 1: Patient handout |
| lary28768-sup-0002-AppendixS2.pdfPDF document, 553.4 KB | APPENDIX 2: ERAS pre-surgery check-list |
| lary28768-sup-0003-AppendixS3.pdfPDF document, 545.5 KB | APPENDIX 3: ERAS post-surgery check-list |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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