{"title":"Decreased Postoperative Emesis and Opioid Use After Implementation of ERAS Protocol for Free Flap Surgery.","authors":"Jesse K Siegel, Kayeromi Gomez, Carol Bier-Laning","doi":"10.1002/ohn.1043","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Enhanced recovery after surgery (ERAS) protocols are designed to improve postoperative outcomes. In this study, we compare outcomes for patients undergoing head and neck free flap surgery at a quaternary care institution before and after an ERAS protocol was implemented.</p><p><strong>Study design: </strong>Retrospective study.</p><p><strong>Setting: </strong>Single quaternary care center.</p><p><strong>Methods: </strong>Retrospective evaluation of outcomes from patients who underwent head and neck surgery with free flap reconstruction prior to ERAS (January 2018 to May 2022, baseline) with patient outcomes after implementation (June 2022 to September 2023, ERAS). Outcomes studied included length of stay (LOS), opioid utilization, postoperative emesis, readmission, and mortality.</p><p><strong>Results: </strong>Patients in the ERAS group had significantly lower opioid utilization (206.84 ± 217 morphine milligram equivalent vs 415.53 ± 431, P < .01) and significantly lower rates of postoperative emesis (1.74% vs 28.27%, P < .01). This difference in emesis remained significant in the subgroup of patients who underwent total laryngectomy. The decreases in opioid use and emesis remained significant in multivariate analyses controlling for demographic factors and surgery type. We found no significant decrease in LOS or mortality.</p><p><strong>Conclusion: </strong>In the year after implementing an ERAS protocol for head and neck free flap surgery, we found significantly lower opioid utilization and the unique finding of lower postoperative emesis overall, including in the laryngectomy subgroup for whom emesis-induced fistula is most impactful. No difference was noted in LOS or mortality. To our knowledge, this is the first study of an ERAS protocol for head and neck surgery to show a decrease in postoperative emesis.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.6000,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Otolaryngology- Head and Neck Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/ohn.1043","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OTORHINOLARYNGOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: Enhanced recovery after surgery (ERAS) protocols are designed to improve postoperative outcomes. In this study, we compare outcomes for patients undergoing head and neck free flap surgery at a quaternary care institution before and after an ERAS protocol was implemented.
Study design: Retrospective study.
Setting: Single quaternary care center.
Methods: Retrospective evaluation of outcomes from patients who underwent head and neck surgery with free flap reconstruction prior to ERAS (January 2018 to May 2022, baseline) with patient outcomes after implementation (June 2022 to September 2023, ERAS). Outcomes studied included length of stay (LOS), opioid utilization, postoperative emesis, readmission, and mortality.
Results: Patients in the ERAS group had significantly lower opioid utilization (206.84 ± 217 morphine milligram equivalent vs 415.53 ± 431, P < .01) and significantly lower rates of postoperative emesis (1.74% vs 28.27%, P < .01). This difference in emesis remained significant in the subgroup of patients who underwent total laryngectomy. The decreases in opioid use and emesis remained significant in multivariate analyses controlling for demographic factors and surgery type. We found no significant decrease in LOS or mortality.
Conclusion: In the year after implementing an ERAS protocol for head and neck free flap surgery, we found significantly lower opioid utilization and the unique finding of lower postoperative emesis overall, including in the laryngectomy subgroup for whom emesis-induced fistula is most impactful. No difference was noted in LOS or mortality. To our knowledge, this is the first study of an ERAS protocol for head and neck surgery to show a decrease in postoperative emesis.
期刊介绍:
Otolaryngology–Head and Neck Surgery (OTO-HNS) is the official peer-reviewed publication of the American Academy of Otolaryngology–Head and Neck Surgery Foundation. The mission of Otolaryngology–Head and Neck Surgery is to publish contemporary, ethical, clinically relevant information in otolaryngology, head and neck surgery (ear, nose, throat, head, and neck disorders) that can be used by otolaryngologists, clinicians, scientists, and specialists to improve patient care and public health.