Standardized Perioperative Protocol and Routine Ketorolac Use for Head and Neck Free Flap Reconstruction

Area of Science:

• Microsurgery
• Head and Neck Reconstruction
• Anesthesiology

Background:

• Optimal perioperative management and anticoagulation for head and neck free flap reconstruction lack consensus.
• Balancing antiplatelet therapy benefits against potential complications is crucial.
• Ketorolac, a platelet inhibitor and analgesic, was integrated into a standardized protocol.

Purpose of the Study:

• To evaluate the impact of a standardized perioperative protocol involving ketorolac.
• To assess complications associated with routine perioperative ketorolac use.
• To analyze outcomes in patients undergoing head and neck free flap reconstruction.

Main Methods:

• Retrospective review of head and neck free flap reconstructions (Oct 2016 - Nov 2019).
• Two patient cohorts: standardized protocol with ketorolac vs. no protocol.
• Analysis of microvascular thrombosis, flap failure, hematoma, ICU stay, and opiate use.

Main Results:

• No microvascular thromboses, flap failures, or hematomas observed in either group.
• Significantly reduced intensive care unit (ICU) length of stay in the protocol group.
• Significantly reduced opiate use in the standardized protocol group.

Conclusions:

• A standardized perioperative protocol for head and neck free flap reconstruction can decrease hospital and ICU length of stay.
• Routine perioperative ketorolac use did not increase complication rates in this diverse patient group.
• The protocol offers a safe and effective approach to perioperative management.