Authors (including presenting author) :
Lau EHL(1), Yeung ZWC(2), Chan PL(1), Cho HW(2), Lai R(2), Ku KM(2), Wu PM(1), Tam MYM(1), Fung WMA(2), Chu KL(3), Lau CTT(4), Tang LMT(5), Chan NSS(5), Chan YTB(6), Tsui MFW(7), Wong KTE(7), Poon SME(8), Lee K(9), Wong WY(1)
Affiliation :
(1) Department of Ear, Nose and Throat, Prince of Wales Hospital, (2) Department of Ear, Nose and Throat, United Christian Hospital, (3) Department of Anaesthesiology and Pain Medicine, United Christian Hospital, (4)Dietetics Department, Prince of Wales Hospital, (5)Physiotherapy Department, Prince of Wales Hospital, (6)Speech Therapy Department, Prince of Wales Hospital, (7)Physiotherapy Department, United Christian Hospital, (8)Speech Therapy Department, United Christian Hospital, (9)Medical Social Service Department, United Christian Hospital
Introduction :
The total number of major head and neck surgeries in the New Territory East Cluster in 2019 was 187, ranking the first among clusters, and has a lower than average post-operative length of stay 10.3 days (HA average 16 days). However, upon stratification of operations requiring flap reconstruction, there is a substantial prolonged hospitalization postoperatively (25.9 days). Enhanced Recovery After Surgery (ERAS) protocol is a multidisciplinary perioperative care pathway including preoperative counselling and nutritional optimization, perioperative analgesic standardization and early mobilization, which improves overall outcomes and provides a wholistic care throughout the journey.
Objectives :
To implement ERAS protocol in the Head and Neck oncological operations in the Department of Ear, Nose and Throat in NTEC and KEC. To observe clinical outcomes before and after ERAS implementation for evidence of improved quality of services and cost-effectiveness. To potentially guide and extend the ERAS protocol to other major Head and Neck operations.
Methodology :
An ERAS protocol was formulated with reference to current literature and a consensus made among NTEC and KEC Head and Neck surgeons with Anaesthetists, dietitians, physiotherapists and speech therapists. All Head and Neck surgeries requiring pedicled or free flap reconstruction were admitted to ERAS protocol. Patients within a similar time-span before ERAS implementation were recruited as control. Post-operative length of stay and morbidities were captured prospectively as primary and secondary outcomes and compared between patients before and after ERAS implementation.
Result & Outcome :
ERAS protocol was implemented in 2019 and 2020 respectively in the ENT departments of KEC and NTEC. The total number of Head and Neck surgeries requiring flap reconstructions recruited were 14 vs 15(ERAS) in KEC and 31 vs 43(ERAS) in NTEC. The post-operative mean length of stay (days) was 25.9 vs 17(ERAS) in NTEC (p=0.001) and 21.9 vs 16.3(ERAS) in KEC (p=0.011). Percentage of major morbidity was 9.7% vs 9.3(ERAS) in NTEC and 14.3 vs 13.3(ERAS) in KEC respectively. Percentage of unplanned readmission was 3.2% vs 4.7%(ERAS) in NTEC. Conclusion: The ERAS protocol has demonstrated significant shorter length of stay, without additional occurrence of major morbidities and unplanned readmissions in Head and Neck pedicle and free flap surgeries. The results were reproducible in both departments of ENT in NTEC and KEC.
