How effective is an algorithm for rapid discharge after transoral robotic surgery (TORS), and what is its effect on post-operative complications?
Background: TORS is most frequently employed for oropharyngeal carcinoma and increasingly for tongue base reduction for obstructive sleep apnea (OSA). Despite multiple references establishing the safety and feasibility of TORS, there has been sparse literature regarding peri-operative care regimens. The fear of post-operative complications may result in longer hospital length of stay (LOS). The authors have standardized the post-operative care pathway since the inception of TORS at their institution, with an emphasis on safe and early hospital discharge.
Explore this issue:November 2014
Study design: Retrospective cohort study of 91 TORS cases of the oropharynx from September 2009 to February 2013.
Setting: Johns Hopkins School of Medicine, Baltimore, Maryland.
Synopsis: The mean LOS was 1.51 days (median/mode of one day). LOS was not correlated with gender, age, benign versus malignant pathology, or site of surgical resection. A difference in the mean LOS was shown for patients with advanced comorbidity, but various tumor characteristics revealed no significant differences in mean LOS. HPV status, smoking status, and a concurrent neck dissection showed no difference in the mean post-operative LOS for squamous cell carcinoma patients undergoing TORS. In total, 11 patients experienced one or more complications during their postoperative course, with the majority of all complications occurring within the first post-operative week; post-operative hemorrhage was the most common complication. There was a trend toward longer LOS for patients receiving OSA treatment, and these patients experienced significantly more post-operative complications (specifically, dehydration). Initiation of oral diet occurred on post-operative day (POD) one for 75 patients. Twelve patients started on POD 2, and three patients started on POD 3. Advanced comorbidity and time to initiation of oral diet of >24 hours were significant predictors of LOS.
Bottom line: Rapid initiation of oral diet and rapid discharge home are feasible and not associated with post-operative complications. Similarly, a concurrent neck dissection does not contribute to LOS or to post-operative complications.
Citation: Richmon JD, Feng AL, Yang W, Starmer H, Gourin C. Feasibility of rapid discharge after transoral robotic surgery of the oropharynx. Laryngoscope. 2014;124:2518-2525.
—Reviewed by Amy Eckner