Enhanced Recovery After Surgery (ERAS) in Head and Neck Oncologic Surgery: A Case-Matched Analysis of Perioperative and
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ORIGINAL ARTICLE – HEAD AND NECK ONCOLOGY
Enhanced Recovery After Surgery (ERAS) in Head and Neck Oncologic Surgery: A Case-Matched Analysis of Perioperative and Pain Outcomes Kimberley L. Kiong, MBBS1, Catherine N. Vu, MD2, Christopher M. K. L. Yao, MD1, Brittany Kruse, BA3, Gang Zheng, MD2, Peirong Yu, MD4, Randal S. Weber, MD1, and Carol M. Lewis, MD, MPH1 1
Division of Surgery, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX; 2Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX; 3Institute for Cancer Care Innovation, The University of Texas MD Anderson Cancer Center, Houston, TX; 4Department of Plastics and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
ABSTRACT Background. Enhanced recovery after surgery (ERAS) pathways are well established in certain surgical specialties because findings have shown significant improvements in outcomes. Convincing literature in head and neck cancer (HNC) surgery is lacking. This study aimed to assess the effect of an ERAS pathway on National Surgical Quality Improvement Program (NSQIP)-based occurrences and pain-related outcomes in HNC surgery. Methods. The study matched 200 patients undergoing head and neck oncologic surgery on an ERAS pathway between 1 March 2016 and 31 March 2019 with control subjects (1:1 ratio) during the same period. Demographic and perioperative data collected from the NSQIP database were extracted. Pain scores and medication usage were electronically extracted from our electronic medical record system and compared. Risk factors for high opioid usage also were assessed.
Electronic supplementary material The online version of this article (https://doi.org/10.1245/s10434-020-09174-2) contains supplementary material, which is available to authorized users. Ó Society of Surgical Oncology 2020 First Received: 28 May 2020 Accepted: 1 September 2020 C. M. Lewis, MD, MPH e-mail: [email protected]
Results. Both groups were statistically similar in baseline characteristics. The ERAS group had fewer planned intensive care unit (ICU) admissions (4% vs. 14%; p \ 0.001), a shorter mean hospital stay (7.2 ± 2.3 vs. 8.7 ± 4.2 days; p \ 0.001), and fewer overall complications (18.6% vs. 27.0%; p = 0.045). Morphine milligram equivalent requirements over 72 h were significantly reduced during 72 h in the ERAS group (138.8 ± 181.5 vs. 207.9 ± 205.5; p \ 0.001). In the multivariate analysis, the risk factors for high opioid analgesic usage included preoperative opioid usage, age younger than 65 years, race, patient-controlled analgesia use, and ICU admission. Conclusion. The study findings showed that ERAS in HNC surgery can result in improved outcomes and resource use, and that these results are sustainable. The outcomes described in this report can be further used to optimize ERAS pathways.
Enhanced recovery after surgery (ERAS) protocols are widespread in fields such as colorectal surgery,1 hepatobiliar
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