Anesthesia for TORS for Oropharyngeal Carcinoma: Factors Associated with Prolonged Phase I Postanesthesia Recovery

Objectives Clinical variables affecting anesthetic recovery following transoral robotic surgery (TORS) to resect oropharyngeal squamous cell carcinoma have not been described. We aimed to explore risk factors associated with prolonged postanesthesia recovery following TORS. Study Design Retrospective case-control study. Setting Tertiary referral center, January 2010 to November 2016. Subjects and Methods Patients included adults undergoing primary TORS +/- neck dissection for oropharyngeal squamous cell carcinoma. Patients were categorized by phase I recovery time into the "goal" recovery group (75th percentile [lower 3 quartiles], n = 272) and the "prolonged" recovery group (n = 91). Univariate and multivariate logistic regression analyses were performed to assess the associations between clinical characteristics and prolonged phase I recovery. Results A total of 363 patients were included. Median (interquartile range) duration of postanesthesia recovery was 1.5 hours (1.0-2.0). Prolonged recovery was associated with isoflurane (odds ratio, 2.83 [95% CI, 1.56-5.14], P < .001), midazolam (2.77 [1.50-5.12], P = .001), and larger opioid doses (1.26 [1.01-1.58] per 10-mg intravenous morphine equivalents, P = .040) and inversely associated with multimodal antiemetic therapy (0.34 [0.15-0.78], P = .011). Prolonged cases had higher rates of postoperative nausea and vomiting (n = 43 [47.2%] vs 86 [31.6%], P = .008), respiratory depression (28 [30.8%] vs 12 [4.4%], P < .001), sedation (Richmond Agitation-Sedation Scale < -2; 26 [28.6%] vs 35 [12.9%], P = .001), severe pain (numeric rating score >= 7; 31 [34.4%] vs 45 [17.2%], P = .001), and longer hospital stays (4 vs 3 days, P < .001). Conclusions Several anesthetic factors are associated with anesthesia recovery duration, which may be shortened by efforts to reduce postoperative sedation, severe pain, and nausea/vomiting. Shortened anesthesia recovery time may reduce hospital stay.