Højvig Jens H, Pedersen Nicolas J, Charabi Birgitte W, Wessel Irene, Jensen Lisa T, Nyberg Jan, Mayman-Holler Nana, Kehlet Henrik, Bonde Christian T
Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Department of Otorhinolaryngology, Head and Neck surgery & Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
JPRAS Open. 2020 Oct 15;26:91-100. doi: 10.1016/j.jpra.2020.09.008. eCollection 2020 Dec.
Microvascular reconstructions after head and neck cancer are among the most complicated procedures in plastic surgery. Postoperative complications are common, which often leads to prolonged hospital stay. Enhanced recovery after surgery (ERAS) is a peri- and postoperative care concept with the aim of achieving pain- and risk-free surgery. It has been previously established as superior to conventional care for a wide variety of procedures, including microsurgical procedures such as reconstructions of the breast. Several ERAS protocols for microvascular head and neck cancer reconstructions have been proposed, although most of these are based on extrapolated evidence from different surgical specialties. Results from the implementation of ERAS for these procedures are inconsistent.
The current study investigates our clinical experience of head and neck cancer reconstruction for the period of 2014-2016 with the aim of establishing a list of functional discharge criteria. By combining these with the current published knowledge on the subject, we developed an ERAS protocol.
We performed 89 microvascular procedures in the study period, of which 58 were in the oral cavity/sinuses and 31 were laryngopharyngeal. Most cases were squamous cell carcinoma (89%). The average LOS was 20.3 days in both groups. Postoperative complications included infection (37%), 30-days re-operations (19%), and re-admissions (17%). Furthermore, we identified the following discharge criteria: adequate pain relief, ambulation, sufficient nutritional intake, normal infection-related blood parameter results and absence of fever, bowel function, and closure of tracheostomy.
Based on our retrospective analysis and identified discharge criteria, we present an approach to develop an ERAS protocol for microvascular reconstruction after head and neck cancer.
头颈部癌症后的微血管重建是整形手术中最复杂的手术之一。术后并发症很常见，这往往导致住院时间延长。术后加速康复（ERAS）是一种围手术期和术后护理理念，旨在实现无痛且无风险的手术。此前已证实，对于包括乳房重建等显微外科手术在内的多种手术，ERAS优于传统护理。虽然已经提出了几种用于头颈部癌症微血管重建的ERAS方案，但其中大多数是基于来自不同外科专业的推断证据。这些手术实施ERAS的结果并不一致。
本研究调查了我们在2014 - 2016年期间对头颈部癌症重建的临床经验，目的是确定一系列功能出院标准。通过将这些标准与当前关于该主题的已发表知识相结合，我们制定了一个ERAS方案。
在研究期间，我们进行了89例微血管手术，其中58例在口腔/鼻窦，31例在喉咽。大多数病例为鳞状细胞癌（89%）。两组的平均住院时间均为20.3天。术后并发症包括感染（37%）、30天再次手术（19%）和再次入院（17%）。此外，我们确定了以下出院标准：疼痛缓解充分、可走动、营养摄入充足、感染相关血液参数结果正常且无发热、肠道功能正常以及气管造口闭合。
基于我们的回顾性分析和确定的出院标准，我们提出了一种为头颈部癌症后微血管重建制定ERAS方案的方法。
