Enhanced Recovery After Surgery Protocol in Transoral Robotic Surgery: A Case–Control Study

INTRODUCTION: 'Enhanced Recovery After Surgery' (ERAS) protocols have been developed for multiple surgical procedures with favourable outcome measures including Length of Stay (LoS). Trans-Oral Robotic Surgery (TORS) has similarly facilitated earlier patient discharges, particularly in comparison to open head and neck surgical techniques. There is a dearth of literature on the effect of ERAS protocols in TORS. We sought to comprehensively examine the effect of a TORS ERAS protocol across several key metrics, with a focus on LoS. METHODS: We conducted a retrospective cohort study following implementation of a TORS ERAS protocol. This protocol was developed at our institution and implemented in 2021; it included key features such as pharyngocutaneous risk stratification and thorough perioperative assessments. Patients managed prior to (p-ERAS) and post implementation (w-ERAS) were separated into two groups, with key outcomes, including LoS, estimated cost per patient, return to swallow, and complication rate, compared. RESULTS: A total of 40 TORS cases were included. Patients managed w-ERAS had a mean adherence rate to protocol of 90%. The w-ERAS group showed a statistically significant reduction in median length of stay by 3.5 days (p = 0.03) when compared to the p-ERAS group. There was also a trend towards decreased median cost per patient as well as decreased median time to oral intake. CONCLUSION: Our study demonstrates an easily implementable protocol for the perioperative management of TORS oncological surgery. The use of this ERAS protocol demonstrated a significant reduction in patient length of stay in a small sample size.