TY - JOUR
T1 - Enhanced Recovery After Surgery (ERAS) in Head and Neck Oncologic Surgery
T2 - A Case-Matched Analysis of Perioperative and Pain Outcomes
AU - Kiong, Kimberley L.
AU - Vu, Catherine N.
AU - Yao, Christopher M.K.L.
AU - Kruse, Brittany
AU - Zheng, Gang
AU - Yu, Peirong
AU - Weber, Randal S.
AU - Lewis, Carol M.
N1 - Funding Information:
The collection of data on perioperative outcomes was partially funded by the John Brooks Williams and Elizabeth Williams endowment.
Publisher Copyright:
© 2020, Society of Surgical Oncology.
PY - 2021/2
Y1 - 2021/2
N2 - 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. 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.
AB - 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. 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.
UR - http://www.scopus.com/inward/record.url?scp=85091298594&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85091298594&partnerID=8YFLogxK
U2 - 10.1245/s10434-020-09174-2
DO - 10.1245/s10434-020-09174-2
M3 - Article
C2 - 32964371
AN - SCOPUS:85091298594
SN - 1068-9265
VL - 28
SP - 867
EP - 876
JO - Annals of surgical oncology
JF - Annals of surgical oncology
IS - 2
ER -