Enhanced recovery after surgery program involving preoperative dexamethasone administration for head and neck surgery with free tissue transfer reconstruction: Single-center prospective observational study
Enhanced recovery after surgery program involving preoperative dexamethasone administration for head and neck surgery with free tissue transfer reconstruction: Single-center prospective observational study
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DOI：
10.1016/j.suronc.2020.04.025
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发表时间：
2020-09-01
影响因子：
2.3
通讯作者：
Matsuura, Kazuto
中科院分区：
文献类型：
--
作者：
Imai, Takayuki;Kurosawa, Koreyuki;Matsuura, Kazuto
背景：基于手术后增强恢复(ERAS)的头颈部游离组织移植重建(HNS-FTTR)术后围手术期处理的报道很少。在这里，我们前瞻性地评估了我们的ERAS计划，包括在HNS-FTTR术前使用糖皮质激素。方法：这项前瞻性研究包括2017年6月至2018年12月在宫城癌症中心接受HNS-FTTR术的60名患者。他们的治疗计划包括根据我们的头颈部计划接受围手术期处理。评估住院时间、早期动员、早期肠内营养和患者满意度的主要结果，并与2014年1月至2016年9月在该院接受HNS-FTTR的对照组患者进行比较。结果：住院时间和出院时间的中位数分别为25天和17天。术后第1天(POD)和第2天(POD2)早期活动率分别为86.0%和96.5%。肠内营养在第1天开始的比例为80.1%，在第2天开始时为100%。术后疼痛控制在平均VAS评分1.51~3.13分。有27.6%的患者术后出现Clavien-Dindo II级或以上的并发症。术前平均QOR40评分为179.6分，术后第3天为146.1分，术后第7天为167.8分。与对照组相比，ERAS组患者的C反应蛋白水平明显降低，白蛋白水平明显升高，体温明显降低，中性粒细胞/淋巴细胞比值降低，体重波动较小，血压下降的发生率较低。结论：采用基于ERAS的围手术期处理的HNS-FTTR患者在POD7达到了早期动员、早期肠内营养、良好的疼痛控制、患者满意度的显著恢复，血流动力学稳定性好，炎症反应轻。
Background: There are few reports on Enhanced Recovery After Surgery (ERAS)-based perioperative management following head and neck surgery with free tissue transfer reconstruction (HNS-FTTR). Here, we prospectively evaluated our ERAS program involving preoperative glucocorticoid administration in HNS-FTTR.Methods: This prospective study included 60 patients who underwent HNS-FTTR at the Miyagi Cancer Center from June 2017 to December 2018. Their treatment plan included receiving perioperative management in accordance with our head and neck ERAS program. Major outcomes of hospitalization periods, early mobilization, early enteral nutrition, and patient satisfaction were assessed, and blood date and vital signs were compared with control patients who underwent HNS-FTTR from January 2014 to September 2016 at our institution before ERAS was implemented.Results: The duration of hospital stay and the duration until completion of the discharge criteria was a median of 25 days and 17 days, respectively. Early mobilization was achieved in 86.0% of the patients at postoperative-day (POD)1 and 96.5% at POD2. Enteral nutrition was started in 80.1% at POD1 and 100% at POD2. Postoperative pain was controlled at mean VAS scores of 1.51-3.13. Clavien-Dindo grade II or higher postoperative complications were evident in 27.6% of the patients. The mean QOR40 score was 179.6 preoperatively, 146.1 at POD3, and 167.8 at POD7. Compared with the control group, there were significantly lower C-reactive protein levels, higher albumin levels, a lower body temperature, a lower neutrophil-to-lymphocyte ratio, less body weight fluctuation, and fewer incidences of decreased blood pressure in the ERAS group.Conclusion: Patients who underwent HNS-FTTR with ERAS-based perioperative management achieved early mobilization, early enteral nutrition, favorable pain control, remarkable recovery of patient satisfaction at POD7, and there was evidence of better hemodynamic stability and less inflammatory response compared with control patients.