Twomey Rosie, Matthews T Wayne, Nakoneshny Steven, Schrag Christiaan, Chandarana Shamir P, Matthews Jennifer, McKenzie David, Hart Robert D, Li Na, Sauro Khara M, Dort Joseph C
Ohlson Research Initiative, Arnie Charbonneau Research Institute, University of Calgary Cumming School of Medicine, 3280 Hospital Dr. NW, Calgary, AB T2N 4Z6, Canada.
O'Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, 3280 Hospital Dr. NW, Calgary, AB T2N 4Z6, Canada.
Cancers (Basel). 2021 Jun 8;13(12):2852. doi: 10.3390/cancers13122852.
Surgery with free flap reconstruction is a standard treatment for head and neck cancer (HNC). Because of the complexity of HNC surgery, recovery can be challenging, and complications are common. One of the foundations of enhanced recovery after surgery (ERAS) is early postoperative mobilization. The ERAS guidelines for HNC surgery with free flap reconstruction recommend mobilization within 24 h. This is based mainly on evidence from other surgical disciplines, and the extent to which mobilization within 24 h improves recovery after HNC surgery has not been explored. This retrospective analysis included 445 patients from the Calgary Head and Neck Enhanced Recovery Program. Mobilization after 24 h was associated with more complications of any type (OR = 1.73, 95% CI [confidence interval] = 1.16-2.57) and more major complications (OR = 1.76; 95% CI = 1.00-3.16). When accounting for patient and clinical factors, mobilization after 48 h was a significant predictor of major complications (OR = 2.61; 95% CI = 1.10-6.21) and prolonged length of stay (>10 days; OR = 2.85, 95% CI = 1.41-5.76). This comprehensive analysis of the impact of early mobilization on postoperative complications and length of stay in a large HNC cohort provides novel evidence supporting adherence to the ERAS early mobilization recommendations. Early mobilization should be a priority for patients undergoing HNC surgery with free flap reconstruction.
游离皮瓣重建手术是头颈癌（HNC）的标准治疗方法。由于HNC手术的复杂性，恢复过程可能具有挑战性，并发症也很常见。术后早期活动是加速康复外科（ERAS）的基础之一。HNC游离皮瓣重建手术的ERAS指南建议在24小时内进行活动。这主要基于其他外科领域的证据，而24小时内的活动对HNC手术后恢复的改善程度尚未得到探讨。这项回顾性分析纳入了来自卡尔加里头颈加速康复项目的445例患者。24小时后进行活动与任何类型的更多并发症（OR = 1.73，95%置信区间[CI] = 1.16 - 2.57）和更多严重并发症（OR = 1.76；95% CI = 1.00 - 3.16）相关。在考虑患者和临床因素时，48小时后进行活动是严重并发症（OR = 2.61；95% CI = 1.10 - 6.21）和住院时间延长（>10天；OR = 2.85，95% CI = 1.41 - 5.76）的显著预测因素。这项对大型HNC队列中早期活动对术后并发症和住院时间影响的综合分析提供了新的证据，支持遵循ERAS早期活动建议。早期活动应是接受HNC游离皮瓣重建手术患者的优先事项。
