What Enhanced Recovery After Surgery Protocols Mean for Otolaryngology

Other Applications in Otolaryngology

Although enhanced recovery protocols are designed for major in-hospital procedures, they can be adopted for many of the ambulatory procedures performed by otolaryngologists, Dr. Govindaraj said. And in many cases, the steps that are needed focus on patient education and optimizing drug therapy, with antibiotic stewardship a prime example.

“The emphasis on antibiotic stewardship is applicable throughout otolaryngology,” Dr. Farwell said. “We [now understand] that antibiotics have been overutilized in the perioperative and therapeutic setting. We are dramatically reducing both the intensity and the duration of our perioperative antibiotics. They are still used for free-flap reconstruction procedures, but we have abandoned their use in routine clean cases.” And that’s a significant improvement, he noted, because “10 years ago, you would [have been] written up if you didn’t prescribe them.”

“I think some of the other protocols, such as hypothermia, early mobilization, [and] reducing the perioperative fluid management, are also applicable across otolaryngology outside of the major free flap surgeries,” he added.

Barriers to ERAS Adoption

According to Dr. Farwell, one of the biggest barriers to the adoption of ERAS protocols is gaps in high-quality data. “Many of these recommendations are based on fairly low-quality evidence, so convincing practitioners to change their approach or their traditional treatment algorithm based on less-than-ideal data is challenging. I think there is an opportunity for us to continue to push ourselves to obtain better data, so that we can strengthen and modify these going forward.”

What concerns Dr. Levine is the protocolization of medicine. “ERAS protocols are guidelines, or guardrails, to give clinicians the sense of the direction they should be moving in to improve patient care, but it does not replace good medical judgement.”

“This is a comprehensive approach to perioperative care, and it really touches on many of our practices. It is imperfect—based on limited data—but I think it encourages surgeons to carefully evaluate each step of the game, so that we can have a cumulative, positive effect on these patients’ outcomes, which provides a better value for our patients,” Dr. Farwell concluded.   

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Nikki Kean is a freelance medical writer based in New Jersey.