Mrs Laura Hughes1, Ms Maria Trajkov1, Ms Emily Calton1, Ms Brooke Ryan1, Ms Catherine Morgan2
1Fiona Stanley Hospital, Murdoch, Australia, 2Curtin University, Bentley, Australia
Abstract:
Background:
ERAS is a multidisciplinary approach aiming to reduce post operative complications and shorten length of stay (LOS) for patients undergoing free flap surgery for head and neck cancer. Dietetics and Speech Pathology interventions aim to improve nutrition and swallowing outcomes. An ERAS guideline was developed at FSH in 2020, we aimed to evaluate dietetic practice against the guideline.
Method:
A retrospective clinical audit was conducted in 44 patients who underwent intra-oral free flap and non-flap laryngectomy surgeries in 2023. Practice was audited in the peri-operative phase (counselling and education), post-operative acute phase (Days 1 – 10) and sub-acute phase (Day 10 – discharge). A binary checklist was developed to determine when an intervention occurred by auditing the digital medical record. Descriptive statistics (mean, SD and frequencies/proportions) were produced for demographics and complication rates. Spearman’s rank correlation explored associations between guideline compliance and clinical outcomes for dietetic interventions.
Results:
The cohort included 26 males (59.1%), and 18 females (40.9%), with a mean (SD) age of 63.5 (11.4) years. The overall compliance for Dietetics was 55.1% (range 17.2%-88.6%) with variation across the pathway (peri-operative: 17.2%, post-operative acute phase range: 58.5%-86.8%, subacute phase 64.4%). A moderately statistically inverse relationship was found between overall compliance with ERAS and complication rates (p= -0.42, p=0.004).
Discussion:
We found higher adherence to guidelines correlates with fewer post operative complications. There was variable adherence to the ERAS dietetic guidelines, particularly in the peri-operative phase. Strategies for improved staff compliance are now needed to optimise patient care.