ERAS for Head and Neck Tissue Transfer Reduces Opioid Usage, Peak Pain Scores, and Blood Utilization

Objectives: We implement a novel enhanced recovery after surgery (ERAS) protocol with pre-operative non-opioid loading, total intravenous anesthesia, multimodal peri-operative analgesia, and restricted red blood cell (pRBC) transfusions. 1) Compare differences in mean postoperative peak pain scores, opioid usage, and pRBC transfusions. 2) Examine changes in overall length of stay (LOS), intensive care unit LOS, complications, and 30-day readmissions. Methods: Retrospective cohort study comparing 132 ERAS vs. 66 non-ERAS patients after HNC tissue transfer reconstruction. Data was collected in a double-blind fashion by two teams. Results: Mean postoperative peak pain scores were lower in the ERAS group up to postoperative day (POD) 2. POD0: 4.6 ± 3.6 vs. 6.5 ± 3.5; P =.004) (POD1: 5.2 ± 3.5 vs. 7.3 ± 2.3; P =.002) (POD2: 4.1 ± 3.5 vs. 6.6 ± 2.8; P =.000). Opioid utilization, converted into morphine milligram equivalents, was decreased in the ERAS group (POD0: 6.0 ± 9.8 vs. 10.3 ± 10.8; P =.010) (POD1: 14.1 ± 22.1 vs. 34.2 ± 23.2; P =.000) (POD2: 11.4 ± 19.7 vs. 37.6 ± 31.7; P =.000) (POD3: 13.7 ± 20.5 vs. 37.9 ± 42.3; P =.000) (POD4: 11.7 ± 17.9 vs. 36.2 ± 39.2; P =.000) (POD5: 10.3 ± 17.9 vs. 35.4 ± 45.6; P =.000). Mean pRBC transfusion rate was lower in ERAS patients (2.1 vs. 3.1 units, P =.017). There were no differences between ERAS and non-ERAS patients in hospital LOS, ICU LOS, complication rates, and 30-day readmissions. Conclusion: Our ERAS pathway reduced postoperative pain, opioid usage, and pRBC transfusions after HNC reconstruction. These benefits were obtained without an increase in hospital or ICU LOS, complications, or readmission rates. Level of Evidence: 3 Laryngoscope, 131:E792–E799, 2021.