Authors (including presenting author) :
Cheng WLO, Chan NS
Affiliation :
Physiotherapy Department, Prince of Wales Hospital
Introduction :
Patients with head and neck surgery often suffered from reduced mobility after operation due to the extensive surgical procedure with flap and/or graft taken over lower limb. Enhanced recovery after surgery (ERAS) is a program that provides perioperative care pathway through the contribution of multidisciplinary team. The aim of ERAS program is to facilitate early recovery for post-operative patients which includes early mobilization i.e. full weight bearing walking exercise especially in patients with head and neck surgery.
Objectives :
The aim of the program is to evaluate the effectiveness of the ERAS program by reviewing patients’ (i) length of stay in hospital after surgery, (ii) Modified Functional Ambulation Classification (MFAC) upon discharge, (iii) number of days required for patient to regain independent mobility post operatively.
Methodology :
This program has been carried out in Prince of Wales Hospital from March to December in 2020. Patients admitted to Prince of Wales Hospital were included if they were (i)admitted for head and/or neck surgery, (ii)reconstruction of flap using site over anterolateral thigh, fibular or anterolateral thigh with graft taken, (iii) no complications or infection post-operatively.
Result & Outcome :
A total of 17 participants were included in this program, with 3 outliers excluded due to flap failure or infection which required re-operation and further wound management. The average length of stay post-operatively for all participants is 13.9 days. In comparison, the average length of stay for patients not under ERAS program from January to September in 2019 is 28.3 days. All participants were able to regain independent mobility upon discharge, with MFAC Category 6. The average number of days for patients to regain independent mobility with anterolateral thigh flap, fibular flap and anterolateral thigh flap with graft were 8.7, 31 and 10.35 respectively. Longer duration was needed for patients with fibular flap to regain independent mobility. It was possibly contributed by the delayed prescription of splint and walking sandal, which was available until walking is allowed. Therefore, orthosis was suggested to be prescribed on post-op day 2 to facilitate early mobilization. ERAS program has demonstrated positive effect over patients with head and neck surgery and thereby will continue to be implemented to enhance early recovery in these patients.
