Enhanced Recovery After Surgery program with dexamethasone administration for major head and neck surgery with free tissue transfer reconstruction: initial institutional experience

Abstract

Objectives: Enhanced Recovery After Surgery (ERAS) protocols promote recovery after various invasive surgeries. Likewise, preoperative glucocorticoid administration can reduce complications after some surgeries. However, the effects of ERAS protocols and glucocorticoid administration in patients undergoing major surgery for head and neck cancer have not been well described. The aim of this study was to evaluate the effect of an ERAS protocol with preoperative glucocorticoid administration in major surgery for head and neck cancer.

Methods: This retrospective study included 28 patients who underwent major head and neck surgery with free tissue transfer reconstruction at our institution from September 2016 to May 2017, after implementation of an ERAS protocol with preoperative glucocorticoid administration. Outcomes in that group were compared with those in a control group that underwent surgery from January 2015 to September 2016, before implementation of the protocol.

Results: Analysis revealed significantly less body weight fluctuation, lower C-reactive protein levels, higher albumin levels, and lower body temperature in the ERAS group than in the control group postoperatively.

Conclusions: Patients undergoing major surgery for head and neck cancer who were treated with the ERAS protocol and preoperative glucocorticoid administration had evidence of better hemodynamic stability and less inflammatory response than control patients.

Chinese abstract

目标：“加强术后恢复”（ERAS）方案促进各种创伤性手术后的恢复。同样, 术前施用糖皮质激素可减少有些手术后的并发症。然而, ERAS方案和糖皮质激素应用于头颈部肿瘤手术患者的效果尚不清楚。本研究的目的是评估ERAS方案并术前施用糖皮质激素对治疗头颈部肿瘤的大手术的效果。

方法：该回顾性分析包括了2016年9月至2017年5月期间在我院接受头颈部大手术 并进行自由组织移植重建的28例患者, 术前实施ERAS方案并施用糖皮质激素。该群患者的结果与2015年1月至2016年9月期间接受手术的对照组的结果进行比较, 后者尚未实施ERAS方案。

结果：分析显示, 与对照组相比, 在实施ERAS的组群中, 术后患者的体重波动显著较少, C反应蛋白水平较低, 白蛋白水平较高, 体温较低。

结论：接受ERAS方案和术前施用糖皮质激素的头颈部肿瘤手术患者比对照组患者具有更好的血流动力学稳定性和更少的炎症反应。

Keywords:

• Head and neck neoplasms
• free tissue flaps
• perioperative care
• glucocorticoids
• postoperative complication
• retrospective studies

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.