Enhanced recovery after surgery program involving preoperative dexamethasone administration for head and neck surgery with free tissue transfer reconstruction: Single-center prospective observational study
| Autor: | Kazuto Matsuura, Takayuki Imai, Sinkichi Morita, Yumiko Momma, Ai Suzuki, Satoshi Saijo, Naoko Satake, Kazuhiro Kishimoto, Yukinori Asada, Keitaro Fujii, Maki Takahashi, Koreyuki Kurosawa, Misato Azuma, Takahiro Goto, Tomoko Yamazaki, Megumi Sasaki |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Antineoplastic Agents Hormonal Vital signs Single Center Dexamethasone 03 medical and health sciences 0302 clinical medicine Patient satisfaction Preoperative Care medicine Humans Prospective Studies 030223 otorhinolaryngology Prospective cohort study Aged business.industry Length of Stay Middle Aged Plastic Surgery Procedures Prognosis Combined Modality Therapy Surgery Parenteral nutrition Oncology Head and Neck Neoplasms 030220 oncology & carcinogenesis Decreased blood pressure Observational study Female business Enhanced Recovery After Surgery medicine.drug Follow-Up Studies |
| Zdroj: | Surgical oncology. 34 |
| ISSN: | 1879-3320 |
| Popis: | Background There are few reports on Enhanced Recovery After Surgery (ERAS)-based perioperative management following head and neck surgery with free tissue transfer reconstruction (HNS-FTTR). Here, we prospectively evaluated our ERAS program involving preoperative glucocorticoid administration in HNS-FTTR. Methods This prospective study included 60 patients who underwent HNS-FTTR at the Miyagi Cancer Center from June 2017 to December 2018. Their treatment plan included receiving perioperative management in accordance with our head and neck ERAS program. Major outcomes of hospitalization periods, early mobilization, early enteral nutrition, and patient satisfaction were assessed, and blood date and vital signs were compared with control patients who underwent HNS-FTTR from January 2014 to September 2016 at our institution before ERAS was implemented. Results The duration of hospital stay and the duration until completion of the discharge criteria was a median of 25 days and 17 days, respectively. Early mobilization was achieved in 86.0% of the patients at postoperative-day (POD)1 and 96.5% at POD2. Enteral nutrition was started in 80.1% at POD1 and 100% at POD2. Postoperative pain was controlled at mean VAS scores of 1.51–3.13. Clavien–Dindo grade II or higher postoperative complications were evident in 27.6% of the patients. The mean QOR40 score was 179.6 preoperatively, 146.1 at POD3, and 167.8 at POD7. Compared with the control group, there were significantly lower C-reactive protein levels, higher albumin levels, a lower body temperature, a lower neutrophil-to-lymphocyte ratio, less body weight fluctuation, and fewer incidences of decreased blood pressure in the ERAS group. Conclusion Patients who underwent HNS-FTTR with ERAS-based perioperative management achieved early mobilization, early enteral nutrition, favorable pain control, remarkable recovery of patient satisfaction at POD7, and there was evidence of better hemodynamic stability and less inflammatory response compared with control patients. |
| Databáze: | OpenAIRE |
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