ERAS for Head and Neck Tissue Transfer Reduces Opioid Usage, Peak Pain Scores, and Blood Utilization
| Autor: | Bhavishya S. Clark, Mark S. Swanson, Uttam K. Sinha, Shane Dickerson, Brian Cameron, Margaret Nurimba, Ksenia Ershova, Valerie Yu, Franklin Wu, Andrew Heng, Niels Kokot, Erik Vanstrum, Ruben Ulloa, William Widjaja, Amit Kochhar, M. P. Kim |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Patient Readmission Perioperative Care Surgical Flaps Article law.invention 03 medical and health sciences 0302 clinical medicine Double-Blind Method law medicine Humans Pain Management Blood Transfusion 030212 general & internal medicine Enhanced recovery after surgery Aged Pain Measurement Retrospective Studies Pain Postoperative Total intravenous anesthesia business.industry Retrospective cohort study Length of Stay Middle Aged Plastic Surgery Procedures Intensive care unit Tissue transfer Otorhinolaryngologic Surgical Procedures Analgesics Opioid Treatment Outcome Otorhinolaryngology Opioid 030220 oncology & carcinogenesis Anesthesia Tissue Transplantation Morphine Female Analgesia Complication business Enhanced Recovery After Surgery Head Neck medicine.drug |
| Zdroj: | Laryngoscope |
| ISSN: | 1531-4995 |
| Popis: | Objectives We implement a novel enhanced recovery after surgery (ERAS) protocol with pre-operative non-opioid loading, total intravenous anesthesia, multimodal peri-operative analgesia, and restricted red blood cell (pRBC) transfusions. 1) Compare differences in mean postoperative peak pain scores, opioid usage, and pRBC transfusions. 2) Examine changes in overall length of stay (LOS), intensive care unit LOS, complications, and 30-day readmissions. Methods Retrospective cohort study comparing 132 ERAS vs. 66 non-ERAS patients after HNC tissue transfer reconstruction. Data was collected in a double-blind fashion by two teams. Results Mean postoperative peak pain scores were lower in the ERAS group up to postoperative day (POD) 2. POD0: 4.6 ± 3.6 vs. 6.5 ± 3.5; P = .004) (POD1: 5.2 ± 3.5 vs. 7.3 ± 2.3; P = .002) (POD2: 4.1 ± 3.5 vs. 6.6 ± 2.8; P = .000). Opioid utilization, converted into morphine milligram equivalents, was decreased in the ERAS group (POD0: 6.0 ± 9.8 vs. 10.3 ± 10.8; P = .010) (POD1: 14.1 ± 22.1 vs. 34.2 ± 23.2; P = .000) (POD2: 11.4 ± 19.7 vs. 37.6 ± 31.7; P = .000) (POD3: 13.7 ± 20.5 vs. 37.9 ± 42.3; P = .000) (POD4: 11.7 ± 17.9 vs. 36.2 ± 39.2; P = .000) (POD5: 10.3 ± 17.9 vs. 35.4 ± 45.6; P = .000). Mean pRBC transfusion rate was lower in ERAS patients (2.1 vs. 3.1 units, P = .017). There were no differences between ERAS and non-ERAS patients in hospital LOS, ICU LOS, complication rates, and 30-day readmissions. Conclusion Our ERAS pathway reduced postoperative pain, opioid usage, and pRBC transfusions after HNC reconstruction. These benefits were obtained without an increase in hospital or ICU LOS, complications, or readmission rates. Level of evidence 3 Laryngoscope, 131:E792-E799, 2021. |
| Databáze: | OpenAIRE |
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