Enhanced recovery after surgery for major head & neck surgery— a narrative review

Abstract

Background and Objective: Enhanced recovery after surgery (ERAS) has a large evidence base from colorectal surgery and is associated with reduced length of stay (LOS), lower cost, fewer complications and improved outcomes. Evidence for the benefit of ERAS across all disciplines within head and neck surgery is now emerging in the literature. This article aims to give an overview of current evidence in the literature supporting the use of ERAS based interventions in head and neck surgery. Methods: A PubMed search for ‘enhanced recovery AND head and neck’ and ‘enhanced recovery AND maxillofacial’ published between 2017 and 2022 was performed. Titles identified were subsequently reviewed. Those with full text available that were deemed relevant and written in English were selected. References for these articles were also reviewed and again those deemed relevant selected. Key Content and Findings: Our review covers the available evidence for ERAS interventions in head and neck surgery in the preoperative, intraoperative and postoperative setting. Conclusions: There is good evidence to support the use of ERAS principles in head and neck surgery. Preoperatively there is focus on good patient education and nutritional assessment and optimisation, Intraoperatively, it is important to maintain physiological norms. Patients may have a difficult airway, requiring coordinated teamwork and planning. Multimodal analgesia and antiemetic prophylaxis will help to improve patient satisfaction and avoid postoperative complications. Free flap monitoring is vital in the first 24 hours following surgery. Routine admission to intensive care unit (ICU), tracheostomy insertion and delayed enteral nutrition for more complex cases have now become outdated. Admission to specialist areas, avoidance of tracheostomies and early nutrition are encouraged and have been shown to reduce LOS with no compromise in outcomes.