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

Area of Science:

• Robotic Surgery
• Surgical Oncology
• Anesthesiology

Background:

• Enhanced Recovery After Surgery (ERAS) protocols optimize surgical outcomes, including reduced Length of Stay (LoS).
• Trans-Oral Robotic Surgery (TORS) enables earlier patient discharge compared to open procedures.
• Limited research exists on ERAS protocol application in TORS.

Purpose of the Study:

• To evaluate the impact of a TORS ERAS protocol on key perioperative metrics.
• To specifically assess the effect of the ERAS protocol on Length of Stay (LoS) in TORS patients.

Main Methods:

• Retrospective cohort study comparing patients before (p-ERAS) and after (w-ERAS) ERAS protocol implementation in 2021.
• Protocol included pharyngocutaneous risk stratification and comprehensive perioperative assessments.
• Key outcomes analyzed: LoS, cost per patient, return to swallow, and complication rates.

Main Results:

• 90% adherence to the ERAS protocol in the w-ERAS group.
• Statistically significant reduction in median LoS by 3.5 days for the w-ERAS group (p=0.03).
• Trends observed towards decreased cost per patient and faster return to oral intake in the w-ERAS group.

Conclusions:

• An easily implementable ERAS protocol for TORS oncological surgery was demonstrated.
• The ERAS protocol led to a significant reduction in patient LoS.
• Findings suggest ERAS protocols are beneficial for TORS perioperative management.