Enhanced Recovery After Surgery–Based Perioperative Protocol for Head and Neck Free Flap Reconstruction. Issue 2 (June 2020)

• Record Type: Journal Article
• Authors: Bertelsen, Caitlin; Hur, Kevin; Nurimba, Margaret; Choi, Janet; Acevedo, Joseph R.; Jackanich, Anna; Sinha, Uttam K.; Kochhar, Amit; Kokot, Niels; Swanson, Mark
• Is Part Of: OTO open. Volume 4:Issue 2(2020)
• Publication Date: 2020-06
• Subjects: free flap -- perioperative care -- early awakening -- enhanced recovery after surgery; Otolaryngology -- Periodicals; Otolaryngology; Electronic journals; Periodicals; 617.51
• DOI: 10.1177/2473974X20931037
• Languages: English
• ISSNs: 2473-974X

Abstract

Objectives: Evaluate an enhanced recovery after surgery (ERAS)–based free flap management protocol implemented at our center. Study Design: Prospective cohort study of patients after implementation of an ERAS-based perioperative care protocol for patients undergoing free flap reconstruction of the head and neck as compared with a historical control group. Setting: Tertiary care academic medical center. Participants and Methods: All patients undergoing free flap reconstruction were prospectively enrolled in the ERAS protocol group. A retrospective control group was identified by randomly selecting an equivalent number of patients from a records search of those undergoing free flap surgery between 2009 and 2015. Blood transfusion, complications, 30-day readmission rates, intensive care unit (ICU) and hospital length of stay, and costs of hospitalization were compared. Results: Sixty-one patients were included in each group. Patients in the ERAS group underwent less frequent flap monitoring by physicians and had lower rates of intraoperative (70.5% vs 86.8%, P = .04) and postoperative (49.2% vs 27.2%, P = .026) blood transfusion, were more likely to be off vasopressors (98.3% vs 50.8%, P < .01) and ventilator support (63.9% vs 9.8%, P < .01) at the conclusion of surgery, and had shorter ICU stays (2.11 vs 3.39 days, P = .017). Length of stay, readmissions, and complication rates did not significantly differ between groups. Conclusion: ERAS-based perioperative practices for head and neck free flap reconstruction can reduce time on the ventilator and in the ICU and the need for vasopressors, blood transfusions, and labor-intensive flap monitoring, without adverse effects on outcomes.