What Enhanced Recovery After Surgery Protocols Mean for Otolaryngology

The program includes recommendations for preoperative education, nutritional care, fluid management, pain management, and postoperative care.
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Enhanced recovery after surgery (ERAS) protocols were first developed more than 20 years ago as a way to standardize best practices in general and colorectal surgery (Br J Anaesth. 1997;78:606-617). As reports of improved outcomes, shorter hospital stays, and enhanced patient satisfaction were published, other surgical specialties began to look at ERAS protocols.

Working with the ERAS Society (erassociety.org), Joseph C. Dort, MD, MSc,  and otolaryngologist–head and neck surgeon at the Cummings School of Medicine at the University of Calgary in Alberta, and Jeffrey Harris, MD, MHA, an otolaryngologist with the department of surgery at the University of Alberta, Edmonton, put together a multinational consortium that wrote ERAS protocols on perioperative care in major head and neck cancer surgery (JAMA Otolaryngol Head Neck Surg. 2017;143:292–303).

The program not only focused on intraoperative practices; it also included recommendations for preoperative education, nutritional care, antibiotic stewardship, analgesic and anesthetic care, fluid management, pain management, and postoperative care (see “ERAS Protocols for Head and Neck Cancer Surgery,” below).

“One of the benefits of ERAS protocols is that it puts what we were already doing in terms of evidence-based best practices into one document to facilitate cross-specialty communication,” said D. Gregory Farwell, MD, professor and vice chair of the department of otolaryngology, division of head and neck surgery and director of head and neck oncology and microvascular surgery at the University of California Davis in Sacramento and co-author of the ERAS article. “I’ve talked to several colleagues across the country who have found this very valuable; it has given them the evidence-based ammunition to make some pretty significant changes in their institution.”

Since implementing the new head and neck cancer surgery protocols at the University of California Davis, “we are noticing that patients are recovering faster [and] spending much less time in the intensive care units and on ventilators, reinforcing what we have learned about admitting patients straight to the floor, early mobilization, and changing our approach to postoperative care,” said Dr. Farwell.

For Adam Levine, MD, professor of anesthesiology, perioperative and pain medicine, otolaryngology, and pharmacological sciences at the Icahn School of Medicine at Mount Sinai in New York, NY, the true advantage of ERAS protocols is that surgeons, anesthesiologists, and nurses are now on the same page. “We have the same goals and objectives—we talked together and have come up with strategies that can be seamlessly deployed pre-, intra-, and postoperatively,” he said.