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. 2022 Aug 19:34:103-113.
doi: 10.1016/j.jpra.2022.08.001. eCollection 2022 Dec.

Enhanced recovery after microvascular reconstruction in head and neck cancer - A prospective study

Jens H Højvig  1 , Birgitte W Charabi  2   3 , Irene Wessel  2 , Lisa T Jensen  1 , Jan Nyberg  4 , Nana Maymann-Holler  5 , Henrik Kehlet  6   3 , Christian T Bonde  1   3
Affiliations

Enhanced recovery after microvascular reconstruction in head and neck cancer - A prospective study

Jens H Højvig et al. JPRAS Open. .

Abstract

Objectives: Patients undergoing microvascular reconstruction after head and neck cancer typically have several comorbidities, and the procedures are often followed by complications and prolonged hospitalization. Consequently, the application of enhanced recovery after surgery (ERAS) for these patients undergoing microvascular reconstruction has gained attention in recent years. ERAS is a peri- and postoperative care concept that has repeatedly shown beneficial results for a wide variety of surgical procedures, including microvascular reconstruction. This study presents the results after the introduction of our ERAS protocol for head and neck cancer reconstruction.

Methods: We prospectively treated 30 consecutive patients according to our ERAS protocol from June 2019 to December 2020 and compared the results of the treated patients with those of patients treated with our traditional recovery after surgery (TRAS) protocol. We are based on our ERAS protocol on the following core elements of recovery: improved patient information, goal-directed fluid therapy, minimally invasive surgery, opioid-sparing multimodal analgesia, early ambulation, and pre-defined functional discharge criteria.

Results: The baseline characteristics of the groups were comparable. The ERAS group had a significantly shorter length of stay (13.1 vs. 20.3 days, p < 0.001), significantly shorter time to ambulation (3.0 days vs. 6.4 days, p < 0.001), shorter time to removal of nasogastric tube (13.3 days vs. 22.7 days, p = 0.05), and fewer tracheostomies performed (10% vs. 90%, p < 0.001). There were no differences in complications, flap survival, or 30-day re-admissions between the two groups.

Conclusion: The introduction of ERAS in patients with head and neck cancer undergoing microvascular reconstruction seems safe and results in improved recovery.

Level of evidence: 3.

Keywords: ERAS; Enhanced recovery after surgery; Head and neck cancer; Head and neck reconstruction; Head and neck surgery; Microsurgery; Oral cavity cancer; Oral cavity squamous cell carcinoma; Perioperative care; Reconstructive surgery.

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Conflict of interest statement

Nothing to disclose

Figures

Figure 1:
Fig. 1
Graphical overview illustrating factors keeping the patients hospitalized at a given time during their course of treatment for the TRAS and ERAS groups.
See this image and copyright information in PMC

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