Volume 134, Issue 2 pp. 732-740

Original Report

Implementation and Outcomes of ERAS Protocol for Major Oncologic Head and Neck Surgery

Alexander T. Murr BS,

Alexander T. Murr BS

orcid.org/0000-0003-1102-9477

School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A.

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Craig Sweeney MD,

Craig Sweeney MD

School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A.

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Nicholas R. Lenze MPH,

Nicholas R. Lenze MPH

orcid.org/0000-0002-2126-6663

School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A.

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Douglas R. Farquhar MD, MPH,

Douglas R. Farquhar MD, MPH

Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A.

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Trevor G. Hackman MD,

Corresponding Author

Trevor G. Hackman MD

[email protected]

orcid.org/0000-0001-9330-2398

Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A.

Send correspondence to Trevor G. Hackman, Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box# 7070, Chapel Hill, NC 27599. Email: [email protected]

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Alexander T. Murr BS,

Alexander T. Murr BS

orcid.org/0000-0003-1102-9477

School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A.

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Craig Sweeney MD,

Craig Sweeney MD

School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A.

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Nicholas R. Lenze MPH,

Nicholas R. Lenze MPH

orcid.org/0000-0002-2126-6663

School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A.

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Douglas R. Farquhar MD, MPH,

Douglas R. Farquhar MD, MPH

Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A.

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Trevor G. Hackman MD,

Corresponding Author

Trevor G. Hackman MD

[email protected]

orcid.org/0000-0001-9330-2398

Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A.

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First published: 19 July 2023

https://doi.org/10.1002/lary.30904

Citations: 4

Editor's Note: This Manuscript was accepted for publication on July 07, 2023.

The authors have no funding, financial relationships, or conflicts of interest to disclose.

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Abstract

Background

Enhanced Recovery After Surgery (ERAS) protocols have been developed and successfully implemented for many surgical specialties, demonstrating reductions in length of stay, post-operative complications, and resource utilization. Currently, there are few documented applications of ERAS protocols in head and neck surgery. Additional description of head and neck surgery protocol design, implementation, and outcomes will help advance postoperative care.

Methods

An ERAS protocol was designed for patients undergoing glossectomy and primary or salvage laryngectomy with or without free flap reconstruction. Following successful protocol implementation, patient outcomes and perioperative metrics were retrospectively reviewed and compared between patients prior to and following the ERAS protocol.

Results

Global comparison of ERAS and control group did not show statistically significant differences in measured perioperative outcomes. There were no statistically significant differences between the ERAS and control groups in age, sex, BMI, surgery type, or cancer stage. The ERAS protocol was associated with reduced variability in hospital length of stay (LOS), demonstrated through tighter interquartile ranges. For patients undergoing salvage laryngectomy, the ERAS protocol was associated with a significant reduction in 30-day readmission rates. Although not statistically significant, the median length of stay in the step-down unit (ISCU) and hospital was lower for specific patient groups.

Conclusion

The implementation and evaluation of the ERAS protocol demonstrated improvement in select patient outcomes as well as areas for process improvement. This study demonstrates the insights that arise from review of this protocol even for an institution with perceived standardized procedures for major oncologic head and neck surgeries.

Level of Evidence

3 Laryngoscope, 134:732–740, 2024

Supporting Information

BIBLIOGRAPHY

1Muller S, Zalunardo MP, Hubner M, Clavien PA, Demartines N. A fast-track program reduces complications and length of hospital stay after open colonic surgery. Gastroenterology. 2009; 136(3): 842-847.e1. https://doi.org/10.1053/J.GASTRO.2008.10.030.
10.1053/j.gastro.2008.10.030
PubMed Web of Science® Google Scholar
2Lassen K, Soop M, Nygren J, et al. Consensus review of optimal perioperative care in colorectal surgery: enhanced recovery after surgery (ERAS) group recommendations. Arch Surg. 2009; 144(10): 961-969. https://doi.org/10.1001/ARCHSURG.2009.170.
10.1001/archsurg.2009.170
PubMed Web of Science® Google Scholar
3Debono B, Corniola MV, Pietton R, Sabatier P, Hamel O, Tessitore E. Benefits of enhanced recovery after surgery for fusion in degenerative spine surgery: impact on outcome, length of stay, and patient satisfaction. Neurosurg Focus. 2019; 46(4): E6. https://doi.org/10.3171/2019.1.FOCUS18669.
10.3171/2019.1.FOCUS18669
PubMed Web of Science® Google Scholar
4Fay EE, Hitti JE, Delgado CM, et al. An enhanced recovery after surgery pathway for cesarean delivery decreases hospital stay and cost. Am J Obstet Gynecol. 2019; 221(4): 349.e1-349.e9. https://doi.org/10.1016/J.AJOG.2019.06.041.
10.1016/j.ajog.2019.06.041
PubMed Web of Science® Google Scholar
5Offodile AC, Gu C, Boukovalas S, et al. Enhanced recovery after surgery (ERAS) pathways in breast reconstruction: systematic review and meta-analysis of the literature. Breast Cancer Res Treat. 2019; 173(1): 65-77. https://doi.org/10.1007/S10549-018-4991-8.
10.1007/s10549-018-4991-8
PubMed Web of Science® Google Scholar
6Adamina M, Kehlet H, Tomlinson GA, Senagore AJ, Delaney CP. Enhanced recovery pathways optimize health outcomes and resource utilization: a meta-analysis of randomized controlled trials in colorectal surgery. Surgery. 2011; 149(6): 830-840. https://doi.org/10.1016/J.SURG.2010.11.003.
10.1016/j.surg.2010.11.003
PubMed Web of Science® Google Scholar
7Teeuwen PHE, Bleichrodt RP, Strik C, et al. Enhanced recovery after surgery (ERAS) versus conventional postoperative care in colorectal surgery. J Gastrointest Surg. 2010; 14(1): 88-95. https://doi.org/10.1007/S11605-009-1037-X.
10.1007/s11605-009-1037-x
PubMed Web of Science® Google Scholar
8Bertazzoni G, Testa G, Tomasoni M, et al. The enhanced recovery after surgery (ERAS) protocol in head and neck cancer: a matched-pair analysis. Acta Otorhinolaryngol Ital. 2022; 42(4): 325-333. https://doi.org/10.14639/0392-100X-N2072.
10.14639/0392-100X-N2072
PubMed Web of Science® Google Scholar
9Højvig JH, Charabi BW, Wessel I, et al. Enhanced recovery after microvascular reconstruction in head and neck cancer—a prospective study. JPRAS Open. 2022; 34: 103-113. https://doi.org/10.1016/J.JPRA.2022.08.001.
10.1016/j.jpra.2022.08.001
PubMed Google Scholar
10Kiong KL, Vu CN, Yao CMKL, et al. Enhanced recovery after surgery (ERAS) in head and neck oncologic surgery: a case-matched analysis of perioperative and pain outcomes. Ann Surg Oncol. 2021; 28(2): 867-876. https://doi.org/10.1245/S10434-020-09174-2.
10.1245/s10434-020-09174-2
PubMed Web of Science® Google Scholar
11Engelman DT, Ben Ali W, Williams JB, et al. Guidelines for perioperative Care in Cardiac Surgery: enhanced recovery after surgery society recommendations. JAMA Surg. 2019; 154(8): 755-766. https://doi.org/10.1001/JAMASURG.2019.1153.
10.1001/jamasurg.2019.1153
PubMed Web of Science® Google Scholar
12Nelson G, Bakkum-Gamez J, Kalogera E, et al. Guidelines for perioperative care in gynecologic/oncology: enhanced recovery after surgery (ERAS) society recommendations-2019 update. Int J Gynecol Cancer. 2019; 29(4): 651-668. https://doi.org/10.1136/IJGC-2019-000356.
10.1136/ijgc-2019-000356
PubMed Web of Science® Google Scholar
13Brindle ME, McDiarmid C, Short K, et al. Consensus guidelines for perioperative Care in Neonatal Intestinal Surgery: enhanced recovery after surgery (ERAS®) society recommendations. World J Surg. 2020; 44(8): 2482-2492. https://doi.org/10.1007/S00268-020-05530-1.
10.1007/s00268-020-05530-1
PubMed Web of Science® Google Scholar
14Low GMI, Kiong KL, Amaku R, et al. Feasibility of an enhanced recovery after surgery (ERAS) pathway for major head and neck oncologic surgery. Am J Otolaryngol. 2020; 41(6):102679. https://doi.org/10.1016/J.AMJOTO.2020.102679.
10.1016/j.amjoto.2020.102679
PubMed Web of Science® Google Scholar
15Prasad A, Chorath K, Barrette LX, et al. Implementation of an enhanced recovery after surgery protocol for head and neck cancer patients: considerations and best practices. World J Otorhinolaryngol Head Neck Surg. 2022; 8(2): 91-95. https://doi.org/10.1002/WJO2.20.
10.1002/wjo2.20
PubMed Google Scholar
16Coyle MJ, Main B, Hughes C, et al. Enhanced recovery after surgery (ERAS) for head and neck oncology patients. Clin Otolaryngol. 2016; 41(2): 118-126. https://doi.org/10.1111/COA.12482.
10.1111/coa.12482
CAS PubMed Web of Science® Google Scholar
17Chorath K, Go B, Shinn JR, et al. Enhanced recovery after surgery for head and neck free flap reconstruction: a systematic review and meta-analysis. Oral Oncol. 2021; 113: 113. https://doi.org/10.1016/J.ORALONCOLOGY.2020.105117.
10.1016/j.oraloncology.2020.105117
Web of Science® Google Scholar
18Dort JC, Farwell DG, Findlay M, et al. Optimal perioperative Care in Major Head and Neck Cancer Surgery with Free Flap Reconstruction: a consensus review and recommendations from the enhanced recovery after surgery society. JAMA Otolaryngol Head Neck Surg. 2017; 143(3): 292-303. https://doi.org/10.1001/JAMAOTO.2016.2981.
10.1001/jamaoto.2016.2981
PubMed Web of Science® Google Scholar
19Bater M, King W, Teare J, D'Souza J. Enhanced recovery in patients having free tissue transfer for head and neck cancer: does it make a difference? Br J Oral Maxillofac Surg. 2017; 55(10): 1024-1029. https://doi.org/10.1016/J.BJOMS.2017.10.012.
10.1016/j.bjoms.2017.10.012
CAS PubMed Web of Science® Google Scholar
20Won HR, An JY, Lee JJ, et al. The effectiveness of an enhanced recovery after surgery protocol in head and neck cancer surgery with free-flap reconstruction. Ann Surg Treat Res. 2019; 97(5): 239-244. https://doi.org/10.4174/ASTR.2019.97.5.239.
10.4174/astr.2019.97.5.239
PubMed Web of Science® Google Scholar

Citing Literature

Volume134, Issue2

February 2024

Pages 732-740

Implementation and Outcomes of ERAS Protocol for Major Oncologic Head and Neck Surgery

Abstract

Background

Methods

Results

Conclusion

Level of Evidence

Supporting Information

BIBLIOGRAPHY

Citing Literature

References

Information

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Implementation and Outcomes of ERAS Protocol for Major Oncologic Head and Neck Surgery

Abstract

Background

Methods

Results

Conclusion

Level of Evidence

Supporting Information

BIBLIOGRAPHY

Citing Literature

References

Related

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