Abstract
Surgery with free flap reconstruction is a standard treatment for head and neck cancer (HNC). Because of the complexity of HNC surgery, recovery can be challenging, and complications are common. One of the foundations of enhanced recovery after surgery (ERAS) is early postoperative mobilization. The ERAS guidelines for HNC surgery with free flap reconstruction recommend mobilization within 24 h. This is based mainly on evidence from other surgical disciplines, and the extent to which mobilization within 24 h improves recovery after HNC surgery has not been explored. This retrospective analysis included 445 patients from the Calgary Head and Neck Enhanced Recovery Program. Mobilization after 24 h was associated with more complications of any type (OR = 1.73, 95% CI [confidence interval] = 1.16-2.57) and more major complications (OR = 1.76; 95% CI = 1.00-3.16). When accounting for patient and clinical factors, mobilization after 48 h was a significant predictor of major complications (OR = 2.61; 95% CI = 1.10-6.21) and prolonged length of stay (>10 days; OR = 2.85, 95% CI = 1.41-5.76). This comprehensive analysis of the impact of early mobilization on postoperative complications and length of stay in a large HNC cohort provides novel evidence supporting adherence to the ERAS early mobilization recommendations. Early mobilization should be a priority for patients undergoing HNC surgery with free flap reconstruction.
Highlights
Head and neck cancer (HNC) ranks amongst the top ten most common types of cancer worldwide [1]
Our study extends the work of others on compliance with Enhanced recovery after surgery (ERAS) early mobilization targets after HNC surgery [21,22,23,24,25]
We have extended the evidence of the importance of mobilization within 24 h after HNC surgery, similar analyses from other institutions will support the generalizability of our findings
Summary
Head and neck cancer (HNC) ranks amongst the top ten most common types of cancer worldwide [1]. Surgery with free flap reconstruction is a standard treatment for HNC. Patients face numerous challenges across the surgical timeline and an extended recovery in the hospital (often 10 days or longer) [2]. At least two-thirds of patients have a postoperative medical or surgical complication in the days after surgery [3]. HNC-specific care pathways optimize care before, during and after these complicated surgical procedures [2,4]. Care pathways specify perioperative interventions and timelines to achieve optimal clinical outcomes and reduce the costs of care. Enhanced recovery after surgery (ERAS) guidelines were initially developed for colorectal cancer [5] but have subsequently been developed for many other surgical disciplines [6] and have become widely adopted. An ERAS guideline for head and neck surgery with free flap reconstruction was published in 2017 [4]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
