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Enhanced recovery program (ERP) in major laryngeal surgery: building a protocol and testing its feasibility
M Gemma1, S Toma2, F Lira Luce2
1Head and Neck Department, Anesthesia and Neurosurgical Intensive Care Unit, San Raffaele Hospital, Vita-Salute University, Milan, Italy.
Summary
Enhanced recovery programs (ERP) are feasible for head and neck cancer surgery. This study adapted ERP principles for laryngeal surgery, showing high adherence and feasibility in 24 patients.
Area of Science:
- Perioperative care and surgical outcomes
- Oncology and head and neck surgery
Background:
- Enhanced Recovery Programs (ERP) are multimodal perioperative care strategies with proven benefits in various surgical fields.
- Existing Enhanced Recovery After Surgery (ERAS®) programs have been successfully implemented across multiple surgical specialties.
- No specific ERP protocol has been previously established for head and neck surgery, particularly laryngeal procedures.
Purpose of the Study:
- To develop an expert-opinion-based Enhanced Recovery Program (ERP) tailored for major laryngeal surgery.
- To assess the feasibility and adherence to the newly developed ERP protocol in patients undergoing major laryngeal surgery.
- To compare outcomes with a historical cohort managed under standard practice.
Main Methods:
- An expert-opinion-based ERP protocol was developed for laryngeal surgery, drawing from established ERAS® principles.
- Twenty-four patients undergoing major laryngeal surgery (total/partial laryngectomies, oropharyngeal tumor removal with reconstruction) were managed under the ERP protocol.
- Adherence rates to ERP components were tracked, and outcomes were compared to a historical control group of 70 patients.
Main Results:
- High adherence to ERP items was observed, with 100% application of nutritional assessment, antibiotic prophylaxis, PONV prophylaxis, and speech therapy targets.
- Some ERP components, such as antibiotic prophylaxis and postoperative speech therapy, were already frequently used in standard practice.
- The incidence of postoperative medical complications was 8.3% in the ERP group.
Conclusions:
- The developed expert-opinion-based ERP protocol for major laryngeal surgery is feasible.
- The study demonstrates high adherence to the ERP components in the initial patient cohort.
- Further assessment is required to quantify the specific benefits of this ERP implementation in laryngeal surgery.
