Gemma M, Toma S, Lira Luce F, Beretta L, Braga M, Bussi M
Head and Neck Department, Anesthesia and Neurosurgical Intensive Care Unit, San Raffaele Hospital, Vita-Salute University, Milan, Italy.
Head and Neck Department, Otorhinolaryngology Unit, San Raffaele Hospital, Vita-Salute University, Milan, Italy.
Acta Otorhinolaryngol Ital. 2017 Dec;37(6):475-478. doi: 10.14639/0392-100X-1091.
Enhanced recovery programs (ERP) represent a multimodal approach to perioperative patient care. The benefits of ERP are well demonstrated in colorectal surgery and Enhanced Recovery After Surgery (ERAS®) programs, that epitomise the ERP concept, have being introduced in different specialties, including vascular, gastric, pancreatic, urogynecologic and orthopaedic surgery. However, no ERP has been proposed for head and neck surgery. We developed an expert-opinion-based ERP for laryngeal surgery based on the key principles of colorectal surgery ERAS®. Twenty-four patients undergoing major laryngeal surgery (total and partial laryngectomies or surgical removal of oropharyngeal tumour with muscle flap reconstruction) were treated according to such an ERP protocol, which differed under several respects from our previous standard practice (described in 70 consecutive patients who underwent major laryngeal surgery before ERP implementation. The adherence rate to the different ERP items is reported. Adherence to ERP items was high. Nutritional assessment, antibiotic prophylaxis, postoperative nausea and vomit (PONV) prophylaxis and postoperative speech therapy targets were applied as required in 100% of cases. Some ERP items (antibiotic prophylaxis, intraoperative infusion rate, and postoperative speech therapy) were already frequently implemented before ERP adoption. Postoperative medical complications occurred in 8.3% of patients. Our expert opinion-based ERP protocol for major laryngeal surgery proved feasible. The degree of benefit deriving from its implementation has yet to be assessed.
加速康复计划（ERP）代表了一种围手术期患者护理的多模式方法。ERP的益处已在结直肠手术中得到充分证明，而体现ERP概念的术后加速康复（ERAS®）计划已被引入不同专科，包括血管外科、胃外科、胰腺外科、泌尿妇科和骨科手术。然而，尚未有人提出针对头颈外科手术的ERP。我们基于结直肠手术ERAS®的关键原则，为喉手术制定了一种基于专家意见的ERP。24例接受主要喉手术（全喉和部分喉切除术或带肌瓣重建的口咽肿瘤手术切除）的患者按照这样一种ERP方案进行治疗，该方案在几个方面与我们之前的标准做法不同（之前的标准做法在ERP实施前对70例连续接受主要喉手术的患者进行了描述）。报告了对不同ERP项目的依从率。对ERP项目的依从性很高。营养评估（100%的病例根据需要进行）、抗生素预防、术后恶心呕吐（PONV）预防和术后言语治疗目标均按要求实施。一些ERP项目（抗生素预防、术中输液速度和术后言语治疗）在采用ERP之前就已经经常实施。8.3%的患者发生了术后医疗并发症。我们基于专家意见的主要喉手术ERP方案被证明是可行的。其实施所带来的益处程度还有待评估。
