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Højvig JH, Pedersen NJ, Charabi BW, et al. Microvascular reconstruction in head and neck cancer - basis for the development of an enhanced recovery protocol. JPRAS Open. 2020;26:91-100doi: 10.1016/j.jpra.2020.09.008.
Højvig, J. H., Pedersen, N. J., Charabi, B. W., Wessel, I., Jensen, L. T., Nyberg, J., Mayman-Holler, N., Kehlet, H., & Bonde, C. T. (2020). Microvascular reconstruction in head and neck cancer - basis for the development of an enhanced recovery protocol. JPRAS open, 2691-100. https://doi.org/10.1016/j.jpra.2020.09.008
Højvig, Jens H, et al. "Microvascular reconstruction in head and neck cancer - basis for the development of an enhanced recovery protocol." JPRAS open vol. 26 (2020): 91-100. doi: https://doi.org/10.1016/j.jpra.2020.09.008
Højvig JH, Pedersen NJ, Charabi BW, Wessel I, Jensen LT, Nyberg J, Mayman-Holler N, Kehlet H, Bonde CT. Microvascular reconstruction in head and neck cancer - basis for the development of an enhanced recovery protocol. JPRAS Open. 2020 Oct 15;26:91-100. doi: 10.1016/j.jpra.2020.09.008. eCollection 2020 Dec. PMID: 33225037; PMCID: PMC7666314.
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JPRAS Open. 2020 Oct 15;26:91-100. doi: 10.1016/j.jpra.2020.09.008. eCollection 2020 Dec.

Microvascular reconstruction in head and neck cancer - basis for the development of an enhanced recovery protocol.

JPRAS open

Jens H Højvig, Nicolas J Pedersen, Birgitte W Charabi, Irene Wessel, Lisa T Jensen, Jan Nyberg, Nana Mayman-Holler, Henrik Kehlet, Christian T Bonde

Affiliations

  1. Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
  2. Department of Otorhinolaryngology, Head and Neck surgery & Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
  3. Department of Oral and Maxillofacial surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
  4. Department of Anaesthesiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
  5. Department of Surgical Pathophysiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.

PMID: 33225037 PMCID: PMC7666314 DOI: 10.1016/j.jpra.2020.09.008

Abstract

INTRODUCTION: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSION: 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.

© 2020 The Authors.

Keywords: ERAS; Head and neck; enhanced recovery after surgery; free flap surgery; head and neck cancer; microvascular reconstruction

Conflict of interest statement

None

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