Department of Otorhinolaryngology, Ochsner Clinic Foundation, New Orleans, Louisiana, USA.
Department of Otolaryngology-Head and Neck Surgery, Tulane University, New Orleans, Louisiana, USA.
Otolaryngol Head Neck Surg. 2023 Apr;168(4):593-601. doi: 10.1177/01945998221082541. Epub 2023 Feb 5.
Enhanced recovery after surgery (ERAS) protocols aim to optimize the pre-, intra-, and postoperative care of patients to improve surgery outcomes, reduce complications, decrease length of stay, and more. We aim to perform a systematic review and meta-analysis of ERAS protocols for head and neck cancer surgery with or without microvascular reconstruction.
PubMed, Embase, and Web of Science databases were queried, and abstracts were screened independently by 2 investigators.
This review was conducted in accordance with the PRISMA guidelines. We included comparative observational studies but excluded animal studies, case reports, and case series.
Of 557 articles initially reviewed by title and/or abstract, we identified 30 for full-text screening, and 9 met the criteria for qualitative synthesis. Meta-analysis of length of stay revealed a mean decrease of 1.37 days (95% CI, 0.77-1.96; I = 0%; P < .00001) with the ERAS group as compared with non-ERAS controls. The standardized mean difference of the morphine milligram equivalent was 0.72 lower (95% CI, 0.26-1.18; I = 82%; P = .002) in the ERAS group vs controls. The quality of studies was moderate with a median MINORS score of 18.5 (range, 13.5-21.5).
Implementation of ERAS protocols can lead to decreases in length of stay and opioid drug utilization. However, further high-quality prospective studies of ERAS protocols are needed, especially with stratified analysis of outcomes based on the type of head and neck cancer surgery.
加速康复外科（ERAS）方案旨在优化患者的术前、术中和术后护理，以改善手术结果、减少并发症、缩短住院时间等。我们旨在对头颈癌手术中是否联合或不联合微血管重建的 ERAS 方案进行系统评价和荟萃分析。
检索了 PubMed、Embase 和 Web of Science 数据库，并由 2 名研究者独立筛选摘要。
本综述按照 PRISMA 指南进行。我们纳入了比较观察性研究，但排除了动物研究、病例报告和病例系列。
在最初通过标题和/或摘要进行审查的 557 篇文章中，我们确定了 30 篇进行全文筛选，其中 9 篇符合定性综合的标准。住院时间的荟萃分析显示，与非 ERAS 对照组相比，ERAS 组的平均住院时间减少了 1.37 天（95%CI，0.77-1.96；I = 0%；P <.00001）。ERAS 组的吗啡毫克当量标准化均数差低 0.72（95%CI，0.26-1.18；I = 82%；P =.002）。研究质量为中等，MINORS 中位数评分为 18.5（范围，13.5-21.5）。
实施 ERAS 方案可缩短住院时间和减少阿片类药物的使用。然而，仍需要更多高质量的前瞻性 ERAS 方案研究，特别是对头颈癌手术类型进行分层分析的结果。
