Enhanced recovery after surgery program involving preoperative dexamethasone administration for head and neck surgery with free tissue transfer reconstruction: Single-center prospective observational study. (September 2020)

• Record Type: Journal Article
• Authors: Imai, Takayuki; Kurosawa, Koreyuki; Asada, Yukinori; Momma, Yumiko; Takahashi, Maki; Satake, Naoko; Azuma, Misato; Suzuki, Ai; Sasaki, Megumi; Morita, Sinkichi; Saijo, Satoshi; Fujii, Keitaro; Kishimoto, Kazuhiro; Yamazaki, Tomoko; Goto, Takahiro; Matsuura, Kazuto
• Is Part Of: Surgical oncology. Volume 34(2020)
• Page Start: 197
• Page End: 205
• Publication Date: 2020-09
• Subjects: Head and neck neoplasms -- Free tissue flaps -- Perioperative care -- Prospective observational study -- Enhanced recovery after surgery; ERAS Enhanced Recovery After Surgery -- HNS-FTTR head and neck surgery with free tissue transfer reconstruction -- POD postoperative-day; Cancer -- Surgery -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Electronic journals; 616.994059
• DOI: 10.1016/j.suronc.2020.04.025
• Languages: English
• ISSNs: 0960-7404

Abstract

Abstract: Background: There are few reports on Enhanced Recovery After Surgery (ERAS)-based perioperative management following head and neck surgery with free tissue transfer reconstruction (HNS-FTTR). Here, we prospectively evaluated our ERAS program involving preoperative glucocorticoid administration in HNS-FTTR. Methods: This prospective study included 60 patients who underwent HNS-FTTR at the Miyagi Cancer Center from June 2017 to December 2018. Their treatment plan included receiving perioperative management in accordance with our head and neck ERAS program. Major outcomes of hospitalization periods, early mobilization, early enteral nutrition, and patient satisfaction were assessed, and blood date and vital signs were compared with control patients who underwent HNS-FTTR from January 2014 to September 2016 at our institution before ERAS was implemented. Results: The duration of hospital stay and the duration until completion of the discharge criteria was a median of 25 days and 17 days, respectively. Early mobilization was achieved in 86.0% of the patients at postoperative-day (POD)1 and 96.5% at POD2. Enteral nutrition was started in 80.1% at POD1 and 100% at POD2. Postoperative pain was controlled at mean VAS scores of 1.51–3.13. Clavien–Dindo grade II or higher postoperative complications were evident in 27.6% of the patients. The mean QOR40 score was 179.6 preoperatively, 146.1 at POD3, and 167.8 at POD7. Compared with the control group, there were significantly lower C-reactive protein levels, higher albumin levels, a lower body temperature, a lower neutrophil-to-lymphocyte ratio, less body weight fluctuation, and fewer incidences of decreased blood pressure in the ERAS group. Conclusion: Patients who underwent HNS-FTTR with ERAS-based perioperative management achieved early mobilization, early enteral nutrition, favorable pain control, remarkable recovery of patient satisfaction at POD7, and there was evidence of better hemodynamic stability and less inflammatory response compared with control patients. Highlights: Perioperative management of HNS-FTTR was prospectively conducted based on the ERAS program. Our ERAS program involved preoperative glucocorticoid administration. Patients achieved early mobilization, early enteral nutrition, favorable pain control, and remarkable recovery. Better hemodynamic stability and less inflammatory response were observed in ERAS patients.