Abstract：
OBJECTIVE: Implementing enhanced recovery after surgery (ERAS) protocols and decreasing length of stay (LOS) have become a priority for major surgeries, including microvascular free tissue transfer (MVFTT) reconstruction of the head and neck. We describe an ERAS protocol with the goal to further reduce length of stay beyond national medians.
METHODS: Retrospective chart review between August 2016 and February 2023, including all patients who underwent MVFTT after oral cavity, skull base, salivary gland, and cutaneous ablative surgery. An ERAS protocol was implemented in March 2020.
RESULTS: A total of 383 patients were included. Approximately 59.8% underwent oral cavity MVFTT, 34.5% cutaneous and lateral skull base, and 5.8% maxillary and anterior skull base. A total of 209 (54.7%) patients had surgery prior to implementation of the ERAS protocol and 174 (45.3%) after. Median LOS decreased from 9 days (interquartile interval [IQR] 8-11) to 6 (IQR 5-7.5, p < 0.0001) following oral cavity MVFTT. For cutaneous and lateral skull base reconstruction, median LOS decreased from 6 days (IQR 5-8) to 3 (IQR 3-7, p < 0.0001). For anterior skull base and sinonasal MVFTT, median LOS decreased from 8 (IQR 7-9) to 5 days (IQR 4.5-7, p = 0.0005). Rate of discharge to skilled nursing or subacute rehabilitation facilities decreased (24% before ERAS, 9.2% after, p < 0.0001). Thirty-day readmission rate was similar before and after implementation (10.5% vs. 10.3, p = 0.954). Discharge to facility was associated with readmission (OR 2.34, 95% CI 1.12-4.89, p = 0.024).
CONCLUSIONS: Implementation of the ERAS protocol was associated with decreased LOS. There was no increase in rate of readmission.
METHODS: N/A Laryngoscope, 2024.
METHODS: Retrospective chart review between August 2016 and February 2023, including all patients who underwent MVFTT after oral cavity, skull base, salivary gland, and cutaneous ablative surgery. An ERAS protocol was implemented in March 2020.
RESULTS: A total of 383 patients were included. Approximately 59.8% underwent oral cavity MVFTT, 34.5% cutaneous and lateral skull base, and 5.8% maxillary and anterior skull base. A total of 209 (54.7%) patients had surgery prior to implementation of the ERAS protocol and 174 (45.3%) after. Median LOS decreased from 9 days (interquartile interval [IQR] 8-11) to 6 (IQR 5-7.5, p < 0.0001) following oral cavity MVFTT. For cutaneous and lateral skull base reconstruction, median LOS decreased from 6 days (IQR 5-8) to 3 (IQR 3-7, p < 0.0001). For anterior skull base and sinonasal MVFTT, median LOS decreased from 8 (IQR 7-9) to 5 days (IQR 4.5-7, p = 0.0005). Rate of discharge to skilled nursing or subacute rehabilitation facilities decreased (24% before ERAS, 9.2% after, p < 0.0001). Thirty-day readmission rate was similar before and after implementation (10.5% vs. 10.3, p = 0.954). Discharge to facility was associated with readmission (OR 2.34, 95% CI 1.12-4.89, p = 0.024).
CONCLUSIONS: Implementation of the ERAS protocol was associated with decreased LOS. There was no increase in rate of readmission.
METHODS: N/A Laryngoscope, 2024.
摘要：
目的：实施增强术后恢复（ERAS）方案和减少住院时间（LOS）已成为主要手术的优先事项，包括头颈部的微血管游离组织移植(MVFTT)重建。我们描述了一种ERAS协议，其目标是进一步减少超出国家中位数的停留时间。
方法：2016年8月至2023年2月的回顾性图表回顾，包括所有在口腔后接受MVFTT的患者，颅底,唾液腺,和皮肤消融手术.ERAS协议于2020年3月实施。
结果：共纳入383例患者。大约59.8%接受口腔MVFTT，34.5%皮肤和外侧颅底，和5.8％的上颌和前颅底。在实施ERAS方案之前，共有209例（54.7％）患者接受了手术，在实施ERAS方案之后，共有174例（45.3％）患者接受了手术。口腔MVFTT后，中位LOS从9天（四分位数间隔[IQR]8-11）降低至6天（IQR5-7.5，p<0.0001）。对于皮肤和外侧颅底重建，中位LOS从6天(IQR5-8)下降至3天(IQR3-7,p<0.0001)。对于前颅底和鼻窦MVFTT，中位LOS从8天(IQR7-9)下降至5天(IQR4.5-7,p=0.0005).熟练护理或亚急性康复机构的出院率下降（ERAS之前为24％，9.2%后，p<0.0001)。实施前后30天的再入院率相似(10.5%与10.3,p=0.954)。出院与再入院相关(OR2.34，95%CI1.12-4.89，p=0.024)。
结论：实施ERAS协议与LOS降低相关。再入院率没有增加。
方法：N/A喉镜，2024.
方法：2016年8月至2023年2月的回顾性图表回顾，包括所有在口腔后接受MVFTT的患者，颅底,唾液腺,和皮肤消融手术.ERAS协议于2020年3月实施。
结果：共纳入383例患者。大约59.8%接受口腔MVFTT，34.5%皮肤和外侧颅底，和5.8％的上颌和前颅底。在实施ERAS方案之前，共有209例（54.7％）患者接受了手术，在实施ERAS方案之后，共有174例（45.3％）患者接受了手术。口腔MVFTT后，中位LOS从9天（四分位数间隔[IQR]8-11）降低至6天（IQR5-7.5，p<0.0001）。对于皮肤和外侧颅底重建，中位LOS从6天(IQR5-8)下降至3天(IQR3-7,p<0.0001)。对于前颅底和鼻窦MVFTT，中位LOS从8天(IQR7-9)下降至5天(IQR4.5-7,p=0.0005).熟练护理或亚急性康复机构的出院率下降（ERAS之前为24％，9.2%后，p<0.0001)。实施前后30天的再入院率相似(10.5%与10.3,p=0.954)。出院与再入院相关(OR2.34，95%CI1.12-4.89，p=0.024)。
结论：实施ERAS协议与LOS降低相关。再入院率没有增加。
方法：N/A喉镜，2024.
