SUCCESSFUL PERIOPERATIVE MANAGEMENT OF HIGH-RISK ELDERLY PATIENTS WITH ADVANCED HEAD & NECK CANCER IN THE COVID ERA. OUR EXPERIENCE.
Rodopi Koursoumi1, Stergios Doumas1, Nikolaos Kalogritsas2, Dimitrios Kanoutos1, Maria Ntalouka3, Eleni Arnaoutoglou3.
1.Department of Oral and Maxillofacial Surgery,
2.Department of Otolaryngology,
3.Department of Anesthesiology, Faculty of Medicine, School of Health Sciences
University General Hospital of Larissa (UHL)
Doi: 10.54936/haoms231o5
INTRODUCTION: Elderly patients with advanced head and neck cancer undergoing major surgery are at high risk due to their co-morbidities and prolonged procedures. Thus, they often require admission in the ICU.
PURPOSE: We herein describe the perioperative management of elderly patients, with significant comorbidities, surgically treated for stage II-IV head and neck cancer with a specialized anesthesia protocol in the COVID-19 era.
MATERIAL - METHOD: In total, 11 consecutive patients (4 female, 7 male, mean age 74 years, ASA III-IV), with advanced cancer involving oral mucosa, salivary glands and metastatic skin cancer were treated in UHL between 3/2021 and 3/2022. Operation duration varied from 5 to 13 hours, as the extent of disease necessitated extirpation and reconstruction with free or regional flaps in most cases. Hence, an individualized and patient-centered approach was implemented, with the preanesthetic evaluation, the utilization of both an enhanced recovery (ERAS), specialized anesthesia protocol and the prompt postoperative care delivered by the anesthesia team. .
RESULT: No intraoperative adverse events were reported. Admissions in ICU were obviated. One patient underwent neck exploration for bleeding control being treated with therapeutic doses of LMWH (grade IIIb Clavien-Dindo). One more patient required blood transfusion (grade II Clavien-Dindo). Donor site wound breakdown was recorded in 4 patients (grade IIIa Clavien-Dindo). Hospital length ranged from 5 to 14 days. 30-day mortality was 0%.
CONCLUSION: Good rapport between involved teams along with the implementation of an individualized perioperative approach of this patient cohort resulted in an uneventful outcome amid the COVID-19 pandemic.
Rodopi Koursoumi1, Stergios Doumas1, Nikolaos Kalogritsas2, Dimitrios Kanoutos1, Maria Ntalouka3, Eleni Arnaoutoglou3.
1.Department of Oral and Maxillofacial Surgery,
2.Department of Otolaryngology,
3.Department of Anesthesiology, Faculty of Medicine, School of Health Sciences
University General Hospital of Larissa (UHL)
Doi: 10.54936/haoms231o5
INTRODUCTION: Elderly patients with advanced head and neck cancer undergoing major surgery are at high risk due to their co-morbidities and prolonged procedures. Thus, they often require admission in the ICU.
PURPOSE: We herein describe the perioperative management of elderly patients, with significant comorbidities, surgically treated for stage II-IV head and neck cancer with a specialized anesthesia protocol in the COVID-19 era.
MATERIAL - METHOD: In total, 11 consecutive patients (4 female, 7 male, mean age 74 years, ASA III-IV), with advanced cancer involving oral mucosa, salivary glands and metastatic skin cancer were treated in UHL between 3/2021 and 3/2022. Operation duration varied from 5 to 13 hours, as the extent of disease necessitated extirpation and reconstruction with free or regional flaps in most cases. Hence, an individualized and patient-centered approach was implemented, with the preanesthetic evaluation, the utilization of both an enhanced recovery (ERAS), specialized anesthesia protocol and the prompt postoperative care delivered by the anesthesia team. .
RESULT: No intraoperative adverse events were reported. Admissions in ICU were obviated. One patient underwent neck exploration for bleeding control being treated with therapeutic doses of LMWH (grade IIIb Clavien-Dindo). One more patient required blood transfusion (grade II Clavien-Dindo). Donor site wound breakdown was recorded in 4 patients (grade IIIa Clavien-Dindo). Hospital length ranged from 5 to 14 days. 30-day mortality was 0%.
CONCLUSION: Good rapport between involved teams along with the implementation of an individualized perioperative approach of this patient cohort resulted in an uneventful outcome amid the COVID-19 pandemic.