Key result
Guideline-concordant early mobilization within 24 hours reduced median hospital length of stay by 2 days (from 12 to 10 days; p<0.001) in patients undergoing head and neck cancer surgery.
Why the study?
ERAS guidelines recommend early postoperative mobilization within 24 h after head and neck cancer surgery with free flap reconstruction, but compliance needed evaluation.
Does implementing ERAS early mobilization recommendations improve compliance and reduce length of stay in patients undergoing head and neck cancer surgery with free flap reconstruction?
Observational (n=445)
No
Does implementing ERAS early mobilization recommendations improve compliance and reduce length of stay in patients undergoing head and neck cancer surgery with free flap reconstruction?
Effect estimate: median reduction of 2 days
Absolute Event Rate: 10% vs 12%
p-value: p=< 0.001
Implementing ERAS early mobilization guidelines significantly increased compliance and reduced hospital length of stay by a median of 2 days in head and neck cancer surgery patients.
Early mobilization within 24 h was associated with shorter stay; leaves open whether ERAS protocols improve outcomes pending randomized trials.
One of the foundational elements of enhanced recovery after surgery (ERAS) guidelines is early postoperative mobilization. For patients undergoing head and neck cancer (HNC) surgery with free flap reconstruction, the ERAS guideline recommends patients be mobilized within 24 h postoperatively. The objective of this study was to evaluate compliance with the ERAS recommendation for early postoperative mobilization in 445 consecutive patients who underwent HNC surgery in the Calgary Head and Neck Enhanced Recovery Program. This retrospective analysis found that recommendation compliance increased by 10% despite a more aggressive target for mobilization (from 48 to 24 h). This resulted in a decrease in postoperative mobilization time and a stark increase in the proportion of patients mobilized within 24 h (from 10% to 64%). There was a significant relationship between compliance with recommended care and time to postoperative mobilization (Spearman’s rho = −0.80; p < 0.001). Hospital length of stay was reduced by a median of 2 days, from 12 (1QR = 9–16) to 10 (1QR = 8–14) days (z = 3.82; p < 0.001) in patients who received guideline-concordant care. Engaging the clinical team and changing the order set to support clinical decision-making resulted in increased adherence to guideline-recommended care for patients undergoing major HNC surgery with free flap reconstruction.
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Twomey et al. (2021) conducted an observational in Head and neck cancer (HNC) surgery with free flap reconstruction (n=445). Guideline-concordant early postoperative mobilization (within 24 hours) vs. Non-guideline-concordant care was evaluated on Hospital length of stay (median reduction of 2 days, p=< 0.001). Guideline-concordant early mobilization within 24 hours reduced median hospital length of stay by 2 days (from 12 to 10 days; p<0.001) in patients undergoing head and neck cancer surgery.
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