Background: Enhanced recovery after surgery (ERAS) pathways have been implemented across multiple surgical specialties and have been found to be successful in reducing post-operative complications and length of stay (LOS) in hospital. They have only more recently been adopted by Head and Neck surgery but there is now a sufficient body of evidence which would benefit from consolidation and review. The purpose of this review is to determine what impact ERAS pathways have on patient outcomes and post-operative recovery following Head and Neck surgery. Methods: A literature search of Pubmed, CINAHL and Google Scholar was conducted. Results were limited to publication between 2013-2021 and those written in English. The search terms used were “enhanced recovery” and “head and neck surgery” or “ERAS” and “head and neck surgery” or “head and neck surgery” and “clinical pathway” or “head and neck surgery” and “fast track”. Results: The search yielded 17 papers for inclusion in the review. 16 of the studies were cohort studies (50% prospective and 50% retrospective) with sample sizes ranging from 31-445. Five studies observed a statistically significant reduction in length of stay (LOS) in intensive care for those in the ERAS cohort, with an average reduction of 3.42 days. Additionally, 73% of studies (n = 11) reported a statistically significant reduction in overall LOS for ERAS patients. Lower analgesic requirements as measured by morphine equivalent dosing (MED) were reported (17.5 mg ± 46 gmg ERAS vs. 82.7 ± 116 mg in the control (p =< 0.001) in combination with lower average pain scores (2.6 ± 1.8 ERAS vs. 3.6 ± 1.9 control (p =< 0.001)). Only one study identified a statistically significant reduction in post-operative complications (pulmonary) of 30% in the ERAS cohort vs. 63% in the control (p =< 0.001). Conclusions: There is evidence to suggest that ERAS pathways can impact positively on post-operative recovery following Head and Neck surgery by reducing overall LOS, LOS in ITU and opioid requirements. However, current evidence is limited and does not give insight into long-term outcomes or the patient experience of ERAS.
{"title":"The Impact of Enhanced Recovery Pathways in Head and Neck Surgery: A Systematic Review","authors":"Mackie-Savage Ursula, Flynn Denise","doi":"10.36959/605/567","DOIUrl":"https://doi.org/10.36959/605/567","url":null,"abstract":"Background: Enhanced recovery after surgery (ERAS) pathways have been implemented across multiple surgical specialties and have been found to be successful in reducing post-operative complications and length of stay (LOS) in hospital. They have only more recently been adopted by Head and Neck surgery but there is now a sufficient body of evidence which would benefit from consolidation and review. The purpose of this review is to determine what impact ERAS pathways have on patient outcomes and post-operative recovery following Head and Neck surgery. Methods: A literature search of Pubmed, CINAHL and Google Scholar was conducted. Results were limited to publication between 2013-2021 and those written in English. The search terms used were “enhanced recovery” and “head and neck surgery” or “ERAS” and “head and neck surgery” or “head and neck surgery” and “clinical pathway” or “head and neck surgery” and “fast track”. Results: The search yielded 17 papers for inclusion in the review. 16 of the studies were cohort studies (50% prospective and 50% retrospective) with sample sizes ranging from 31-445. Five studies observed a statistically significant reduction in length of stay (LOS) in intensive care for those in the ERAS cohort, with an average reduction of 3.42 days. Additionally, 73% of studies (n = 11) reported a statistically significant reduction in overall LOS for ERAS patients. Lower analgesic requirements as measured by morphine equivalent dosing (MED) were reported (17.5 mg ± 46 gmg ERAS vs. 82.7 ± 116 mg in the control (p =< 0.001) in combination with lower average pain scores (2.6 ± 1.8 ERAS vs. 3.6 ± 1.9 control (p =< 0.001)). Only one study identified a statistically significant reduction in post-operative complications (pulmonary) of 30% in the ERAS cohort vs. 63% in the control (p =< 0.001). Conclusions: There is evidence to suggest that ERAS pathways can impact positively on post-operative recovery following Head and Neck surgery by reducing overall LOS, LOS in ITU and opioid requirements. However, current evidence is limited and does not give insight into long-term outcomes or the patient experience of ERAS.","PeriodicalId":93302,"journal":{"name":"International journal of head and neck surgery","volume":"77 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74923300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Thyroid surgeries are the most frequently performed endocrine procedures worldwide. The recurrent laryngeal nerve (RLN) shows some anatomical variations that can potentially compromise the safety of thyroid surgery, Hence, Thyroid surgeons should have a number of different techniques available in the event that identification of the RLN proves troublesome. Moreover, sufficient knowledge of surgical anatomy, clinical experience, and meticulous surgical techniques are key factors in the identification and safe dissection of the RLN. In this article, we will discuss the Anatomy & variations in Recurrent Laryngeal Nerve, possible approaches to identify it & how to minimize the incidence of inadvertent injury to the nerve.
{"title":"A Focused Review on the Approach to the Recurrent Laryngeal Nerve & Identification during Thyroidectomy","authors":"Alarnaout Sabah, Abdulsamad Ahmed S.","doi":"10.36959/605/568","DOIUrl":"https://doi.org/10.36959/605/568","url":null,"abstract":"Thyroid surgeries are the most frequently performed endocrine procedures worldwide. The recurrent laryngeal nerve (RLN) shows some anatomical variations that can potentially compromise the safety of thyroid surgery, Hence, Thyroid surgeons should have a number of different techniques available in the event that identification of the RLN proves troublesome. Moreover, sufficient knowledge of surgical anatomy, clinical experience, and meticulous surgical techniques are key factors in the identification and safe dissection of the RLN. In this article, we will discuss the Anatomy & variations in Recurrent Laryngeal Nerve, possible approaches to identify it & how to minimize the incidence of inadvertent injury to the nerve.","PeriodicalId":93302,"journal":{"name":"International journal of head and neck surgery","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81580157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Editorial","authors":"Jean-Jacques Nattiez","doi":"10.5005/ijhns-12-4-iv","DOIUrl":"https://doi.org/10.5005/ijhns-12-4-iv","url":null,"abstract":"","PeriodicalId":93302,"journal":{"name":"International journal of head and neck surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47679843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Editorial","authors":"D. A. Joshi, Dr Inna A Husain","doi":"10.5005/ijhns-13-1-iv","DOIUrl":"https://doi.org/10.5005/ijhns-13-1-iv","url":null,"abstract":"","PeriodicalId":93302,"journal":{"name":"International journal of head and neck surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48144741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-19DOI: 10.5005/jp-journals-10001-1514
Abdullah Alanazi, A. Karas, I. Husain
The aim of this article is to describe the pathogenesis, etiology, clinical course, prevention, and management of recurrent respiratory papillomatosis (RRP). RRP is a challenging chronic disease of the respiratory tract that occurs in both children and adults. It is caused by human papillomavirus (HPV), with more than 90% caused by HPV 6 and HPV 11 types. While there is no definitive treatment for RRP, the goal of treatment focuses on improving voice quality and maintaining airway patency. The clinical presentation is nonspecific with the majority of patients presenting with hoarseness, stridor, or dyspnea. Surgical management is the mainstay of treatment of RRP, and about 20% of the patients benefit from adjuvant therapies including cidofovir, bevacizumab, interferon, and others. Prevention of the disease with the HPV vaccine and practicing safe sex may play a major role in decreasing the incidence of HPV infection and RRP.
{"title":"Recurrent Respiratory Papillomatosis: An Update","authors":"Abdullah Alanazi, A. Karas, I. Husain","doi":"10.5005/jp-journals-10001-1514","DOIUrl":"https://doi.org/10.5005/jp-journals-10001-1514","url":null,"abstract":"The aim of this article is to describe the pathogenesis, etiology, clinical course, prevention, and management of recurrent respiratory papillomatosis (RRP). RRP is a challenging chronic disease of the respiratory tract that occurs in both children and adults. It is caused by human papillomavirus (HPV), with more than 90% caused by HPV 6 and HPV 11 types. While there is no definitive treatment for RRP, the goal of treatment focuses on improving voice quality and maintaining airway patency. The clinical presentation is nonspecific with the majority of patients presenting with hoarseness, stridor, or dyspnea. Surgical management is the mainstay of treatment of RRP, and about 20% of the patients benefit from adjuvant therapies including cidofovir, bevacizumab, interferon, and others. Prevention of the disease with the HPV vaccine and practicing safe sex may play a major role in decreasing the incidence of HPV infection and RRP.","PeriodicalId":93302,"journal":{"name":"International journal of head and neck surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43378132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-19DOI: 10.5005/jp-journals-10001-1525
Jayakumar R Menon
{"title":"Pharyngeal Dysphagia","authors":"Jayakumar R Menon","doi":"10.5005/jp-journals-10001-1525","DOIUrl":"https://doi.org/10.5005/jp-journals-10001-1525","url":null,"abstract":"","PeriodicalId":93302,"journal":{"name":"International journal of head and neck surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42120950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-19DOI: 10.5005/jp-journals-10001-1524
Taylor G Lackey, Carolyn A Chabuz, Daniel S Fink
{"title":"Posterior Glottic Stenosis: A Review of Surgical Management Outcomes","authors":"Taylor G Lackey, Carolyn A Chabuz, Daniel S Fink","doi":"10.5005/jp-journals-10001-1524","DOIUrl":"https://doi.org/10.5005/jp-journals-10001-1524","url":null,"abstract":"","PeriodicalId":93302,"journal":{"name":"International journal of head and neck surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44296399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-19DOI: 10.5005/jp-journals-10001-1518
Shannon M. Theis, Abbey Carlson
{"title":"Voice Therapy","authors":"Shannon M. Theis, Abbey Carlson","doi":"10.5005/jp-journals-10001-1518","DOIUrl":"https://doi.org/10.5005/jp-journals-10001-1518","url":null,"abstract":"","PeriodicalId":93302,"journal":{"name":"International journal of head and neck surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49158342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-19DOI: 10.5005/jp-journals-10001-1519
Anagha Atul Joshi, Bhagyashri Chiplunkar
{"title":"Laryngopharyngeal Reflux","authors":"Anagha Atul Joshi, Bhagyashri Chiplunkar","doi":"10.5005/jp-journals-10001-1519","DOIUrl":"https://doi.org/10.5005/jp-journals-10001-1519","url":null,"abstract":"","PeriodicalId":93302,"journal":{"name":"International journal of head and neck surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47873172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-19DOI: 10.5005/jp-journals-10001-1521
Tiffany V Wang, P. Song
{"title":"Neurological Voice Disorders: A Review","authors":"Tiffany V Wang, P. Song","doi":"10.5005/jp-journals-10001-1521","DOIUrl":"https://doi.org/10.5005/jp-journals-10001-1521","url":null,"abstract":"","PeriodicalId":93302,"journal":{"name":"International journal of head and neck surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42787401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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