The Impact of Enhanced Recovery Pathways in Head and Neck Surgery: A Systematic Review

Background: Enhanced recovery after surgery (ERAS) pathways have been implemented across multiple surgical specialties and have been found to be successful in reducing post-operative complications and length of stay (LOS) in hospital. They have only more recently been adopted by Head and Neck surgery but there is now a sufficient body of evidence which would benefit from consolidation and review. The purpose of this review is to determine what impact ERAS pathways have on patient outcomes and post-operative recovery following Head and Neck surgery. Methods: A literature search of Pubmed, CINAHL and Google Scholar was conducted. Results were limited to publication between 2013-2021 and those written in English. The search terms used were “enhanced recovery” and “head and neck surgery” or “ERAS” and “head and neck surgery” or “head and neck surgery” and “clinical pathway” or “head and neck surgery” and “fast track”. Results: The search yielded 17 papers for inclusion in the review. 16 of the studies were cohort studies (50% prospective and 50% retrospective) with sample sizes ranging from 31-445. Five studies observed a statistically significant reduction in length of stay (LOS) in intensive care for those in the ERAS cohort, with an average reduction of 3.42 days. Additionally, 73% of studies (n = 11) reported a statistically significant reduction in overall LOS for ERAS patients. Lower analgesic requirements as measured by morphine equivalent dosing (MED) were reported (17.5 mg ± 46 gmg ERAS vs. 82.7 ± 116 mg in the control (p =< 0.001) in combination with lower average pain scores (2.6 ± 1.8 ERAS vs. 3.6 ± 1.9 control (p =< 0.001)). Only one study identified a statistically significant reduction in post-operative complications (pulmonary) of 30% in the ERAS cohort vs. 63% in the control (p =< 0.001). Conclusions: There is evidence to suggest that ERAS pathways can impact positively on post-operative recovery following Head and Neck surgery by reducing overall LOS, LOS in ITU and opioid requirements. However, current evidence is limited and does not give insight into long-term outcomes or the patient experience of ERAS.