Skip to main content

ERAS in Otolaryngology-Head and Neck Surgery

  • Chapter
  • First Online:
Enhanced Recovery After Surgery
  • 3102 Accesses

Abstract

Otorhinolaryngology (ORL)/otolaryngology-head and neck surgery encompasses a broad range of diseases and procedures. Many ORL procedures are performed on a day surgery basis and are therefore not usually the focus of enhanced recovery after surgery (ERAS) protocols. This chapter will primarily consider management of patients undergoing major head and neck resection with free flap reconstruction while recognizing that ERAS principles can easily be applied to other surgical treatments within ORL. Current evidence reveals that care pathways, fast-track protocols, and ERAS all show meaningful improvements in clinical outcomes while reducing length of stay (LOS) and costs of care. We conclude that ERAS approaches should be more broadly applied within ORL.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Wennberg J, Gittelsohn. Small area variations in health care delivery. Science. 1973;182(4117):1102–8.

    Article  CAS  Google Scholar 

  2. Wennberg JE, Fisher ES, Skinner JS. Geography and the debate over Medicare reform. Health Aff (Millwood). 2002 Jul-Dec;Suppl Web Exclusives:W96–114.

    Google Scholar 

  3. Medicine Io. In: Kohn LT, Corrigan JM, Donaldson MS, editors. To err is human: building a safer health system. Washington, DC: The National Academies Press; 2000.

    Google Scholar 

  4. Schumann R, Shikora S, Weiss JM, Wurm H, Strassels S, Carr DB. A comparison of multimodal perioperative analgesia to epidural pain management after gastric bypass surgery. Anesth Analg. 2003;96(2):469–74, table of contents.

    PubMed  Google Scholar 

  5. Institute of Medicine (U.S.). Committee on Quality of Health Care in America. Crossing the quality chasm : a new health system for the 21st century. Washington, D.C.: National Academy Press; 2001.

    Google Scholar 

  6. Baker GR, Norton PG, Flintoft V, Blais R, Brown A, Cox J, et al. The Canadian adverse events study: the incidence of adverse events among hospital patients in Canada. CMAJ. 2004;170(11):1678–86.

    Article  Google Scholar 

  7. McGlynn EA, Asch SM, Adams J, Keesey J, Hicks J, DeCristofaro A, et al. The quality of health care delivered to adults in the United States. N Engl J Med. 2003;348(26):2635–45.

    Article  Google Scholar 

  8. Morris AH. Adult respiratory distress syndrome and new modes of mechanical ventilation: reducing the complications of high volume and high pressure. New Horiz. 1994;2(1):19–33.

    CAS  PubMed  Google Scholar 

  9. James BCL, Lazar JS. Sustaining and extending clinical improvements: a health system’s use of clinical programs to build quality infrastructure. In: Nelson ECB, Batalden PB, Lazar JS, editors. Practice-based learning and improvement: a clinical improvement action guide. 2nd ed. Oakbrook Terrance: Joint Commission Resources Mission; 2007. p. 95–108.

    Google Scholar 

  10. Cohen J, Stock M, Andersen P, Everts E. Critical pathways for head and neck surgery. Development and implementation. Arch Otolaryngol Head Neck Surg. 1997;123(1):11–4.

    Article  CAS  Google Scholar 

  11. Hanna E, Schultz S, Doctor D, Vural E, Stern S, Suen J. Development and implementation of a clinical pathway for patients undergoing total laryngectomy: impact on cost and quality of care. Arch Otolaryngol Head Neck Surg. 1999;125(11):1247–51.

    Article  CAS  Google Scholar 

  12. Gendron KM, Lai SY, Weinstein GS, Chalian AA, Husbands JM, Wolf PF, et al. Clinical care pathway for head and neck cancer: a valuable tool for decreasing resource utilization. Arch Otolaryngol Head Neck Surg. 2002;128(3):258–62.

    Article  Google Scholar 

  13. Husbands JM, Weber RS, Karpati RL, Weinstein GS, Chalian AA, Goldberg AN, et al. Clinical care pathways: decreasing resource utilization in head and neck surgical patients. Otolaryngol Head Neck Surg. 1999;121(6):755–9.

    Article  CAS  Google Scholar 

  14. Chen AY, Callender D, Mansyur C, Reyna KM, Limitone E, Goepfert H. The impact of clinical pathways on the practice of head and neck oncologic surgery: the University of Texas M. D. Anderson Cancer Center experience. Arch Otolaryngol Head Neck Surg. 2000;126(3):322–6.

    Article  CAS  Google Scholar 

  15. Rogers SN, Naylor R, Potter L, Magennis P. Three years' experience of collaborative care pathways on a maxillofacial ward. Br J Oral Maxillofac Surg. 2000;38(2):132–7.

    Article  CAS  Google Scholar 

  16. Sherman D, Matthews TW, Lampe H, LeBlanc S. Laryngectomy clinical pathway: development and review. J Otolaryngol. 2001;30(2):115–20.

    Article  CAS  Google Scholar 

  17. Chalian AA, Kagan SH, Goldberg AN, Gottschalk A, Dakunchak A, Weinstein GS, et al. Design and impact of intraoperative pathways for head and neck resection and reconstruction. Arch Otolaryngol Head Neck Surg. 2002;128(8):892–6.

    Article  Google Scholar 

  18. Kagan SH, Chalian AA, Goldberg AN, Rontal ML, Weinstein GS, Prior B, et al. Impact of age on clinical care pathway length of stay after complex head and neck resection. Head Neck. 2002;24(6):545–8; discussion.

    Article  Google Scholar 

  19. Yueh B, Weaver EM, Bradley EH, Krumholz HM, Heagerty P, Conley A, et al. A critical evaluation of critical pathways in head and neck cancer. Arch Otolaryngol Head Neck Surg. 2003;129(1):89–95.

    Article  Google Scholar 

  20. Dautremont JF, Rudmik LR, Yeung J, Asante T, Nakoneshny SC, Hoy M, et al. Cost-effectiveness analysis of a postoperative clinical care pathway in head and neck surgery with microvascular reconstruction. J Otolaryngol Head Neck Surg = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale. 2013;42:59.

    Google Scholar 

  21. Smith KA, Matthews TW, Dube M, Spence G, Dort JC. Changing practice and improving care using a low-risk tracheotomy clinical pathway. JAMA Otolaryngol Head Neck Surg. 2014;140(7):630–4.

    Article  Google Scholar 

  22. Smith MD, McCall J, Plank L, Herbison GP, Soop M, Nygren J. Preoperative carbohydrate treatment for enhancing recovery after elective surgery. Cochrane Database Syst Rev. 2014;8:CD009161.

    Google Scholar 

  23. Yeung JK, Dautremont JF, Harrop AR, Asante T, Hirani N, Nakoneshny SC, et al. Reduction of pulmonary complications and hospital length of stay with a clinical care pathway after head and neck reconstruction. Plast Reconstr Surg. 2014;133(6):1477–84.

    Article  CAS  Google Scholar 

  24. Dautremont JF, Rudmik LR, Nakoneshny SC, Chandarana SP, Matthews TW, Schrag C, et al. Understanding the impact of a clinical care pathway for major head and neck cancer resection on postdischarge healthcare utilization. Head Neck. 2016;38(Suppl 1):E1216–20.

    Article  Google Scholar 

  25. Gordon SA, Reiter ER. Effectiveness of critical care pathways for head and neck cancer surgery: a systematic review. Head Neck. 2016;38(9):1421–7.

    Article  Google Scholar 

  26. Bater M, King W, Teare J, D'Souza J. Enhanced recovery in patients having free tissue transfer for head and neck cancer: does it make a difference? Br J Oral Maxillofac Surg. 2017;55(10):1024–9.

    Article  CAS  Google Scholar 

  27. Yetzer JG, Pirgousis P, Li Z, Fernandes R. Clinical pathway implementation improves efficiency of care in a Maxillofacial Head and Neck Surgery Unit. J Oral Maxillofac Surg. 2017;75(1):190–6.

    Article  Google Scholar 

  28. Kehlet H, Mogensen T. Hospital stay of 2 days after open sigmoidectomy with a multimodal rehabilitation programme. Br J Surg. 1999;86(2):227–30.

    Article  CAS  Google Scholar 

  29. Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg. 2002;183(6):630–41.

    Article  Google Scholar 

  30. Fearon KC, Ljungqvist O, Von Meyenfeldt M, Revhaug A, Dejong CH, Lassen K, et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr. 2005;24(3):466–77.

    Article  CAS  Google Scholar 

  31. Feldheiser A, Aziz O, Baldini G, Cox BP, Fearon KC, Feldman LS, et al. Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 2: consensus statement for anaesthesia practice. Acta Anaesthesiol Scand. 2016;60(3):289–334.

    Article  CAS  Google Scholar 

  32. Scott MJ, Baldini G, Fearon KC, Feldheiser A, Feldman LS, Gan TJ, et al. Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 1: pathophysiological considerations. Acta Anaesthesiol Scand. 2015;59(10):1212–31.

    Article  CAS  Google Scholar 

  33. Dort JC, Farwell DG, Findlay M, Huber GF, Kerr P, Shea-Budgell MA, et al. Optimal perioperative care in major head and neck cancer surgery with free flap reconstruction: a consensus review and recommendations from the enhanced recovery after surgery society. JAMA Otolaryngol Head Neck Surg. 2017;143(3):292–303.

    Article  Google Scholar 

  34. Coyle MJ, Main B, Hughes C, Craven R, Alexander R, Porter G, et al. Enhanced recovery after surgery (ERAS) for head and neck oncology patients. Clin Otolaryngol. 2016;41(2):118–26.

    Article  CAS  Google Scholar 

  35. Gramlich LM. Implementation of Enhanced Recovery after Surgery: a strategy to transform surgical care across a health system. Implement Sci. 2017;12:1–17.

    Article  Google Scholar 

  36. Thanh NX, Chuck AW, Wasylak T, Lawrence J, Faris P, Ljungqvist O, et al. An economic evaluation of the Enhanced Recovery After Surgery (ERAS) multisite implementation program for colorectal surgery in Alberta. Can J Surg. 2016;59(6):415–21.

    Article  Google Scholar 

  37. AlBalawi Z, Gramlich L, Nelson G, Senior P, Youngson E, McAlister FA. The impact of the implementation of the Enhanced Recovery After Surgery (ERAS((R))) Program in an entire health system: a natural experiment in Alberta, Canada. World J Surg. 2018;42(9):2691–700.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Joseph C. Dort .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Dort, J.C. (2020). ERAS in Otolaryngology-Head and Neck Surgery. In: Ljungqvist, O., Francis, N., Urman, R. (eds) Enhanced Recovery After Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-33443-7_50

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-33443-7_50

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-33442-0

  • Online ISBN: 978-3-030-33443-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics