{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T21:49:06Z","timestamp":1790027346078,"version":"4.0.1"},"reference-count":11,"publisher":"Cambridge University Press (CUP)","issue":"S2","license":[{"start":{"date-parts":[[2016,5,12]],"date-time":"2016-05-12T00:00:00Z","timestamp":1463011200000},"content-version":"unspecified","delay-in-days":11,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Laryngol. Otol."],"published-print":{"date-parts":[[2016,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. This paper provides recommendations on the pre-treatment clinical assessment of patients presenting with head and neck cancer.<\/jats:p><jats:sec id=\"S0022215116000372_sec_a1\"><jats:title>Recommendations<\/jats:title><jats:p>\u2022 Comorbidity data should be collected as it is important in the analysis of survival, quality of life and functional outcomes after treatment as well as for comparing results of different treatment regimens and different centres. (R)<\/jats:p><jats:p>\u2022 Patients with hypertension of over 180\/110 or associated target organ damage, should have antihypertensive medication started pre-operatively as per British Hypertension Society guidelines. (R)<\/jats:p><jats:p>\u2022 Rapidly correcting pre-operative hypertension with beta blockade appears to cause higher mortality due to stroke and hypotension and should not be used. (R)<\/jats:p><jats:p>\u2022 Patients with poorly controlled or unstable ischaemic heart disease should be referred for cardiology assessment pre-operatively. (G)<\/jats:p><jats:p>\u2022 Patients within one year of drug eluting stents should be discussed with the cardiologist who was responsible for their percutaneous coronary intervention pre-operatively with regard to cessation of antiplatelet medication due to risk of stent thrombosis. (G)<\/jats:p><jats:p>\u2022 Patients with multiple recent stents should be managed in a centre with access to interventional cardiology. (G)<\/jats:p><jats:p>\u2022 Surgery after myocardial infarction should be delayed if possible to reduce mortality risk. (R)<\/jats:p><jats:p>\u2022 Patients with critical aortic stenosis (AS) should be considered for pre-operative intervention. (G)<\/jats:p><jats:p>\u2022 Clopidogrel should be discontinued 7 days pre-operatively; warfarin should be discontinued 5 days pre-operatively. (R)<\/jats:p><jats:p>\u2022 Patients with thromboembolic disease or artificial heart valves require heparin therapy to bridge peri-operative warfarin cessation, this should start 2 days after last warfarin dose. (R)<\/jats:p><jats:p>\u2022 Cardiac drugs other than angotensin-converting enzyme inhibitors and angiotensin II antagonists should be continued including on the day of surgery. (R)<\/jats:p><jats:p>\u2022 Angotensin-converting enzyme inhibitors and angiotensin II antagonists should be withheld on the day of surgery unless they are for the treatment of heart failure. (R)<\/jats:p><jats:p>\u2022 Post-operative care in a critical care area should be considered for patients with heart failure or significant diastolic dysfunction. (R)<\/jats:p><jats:p>\u2022 Patients with respiratory disease should have their peri-operative respiratory failure risk assessed and critical care booked accordingly. (G)<\/jats:p><jats:p>\u2022 Patients with severe lung disease should be assessed for right heart disease pre-operatively. (G)<\/jats:p><jats:p>\u2022 Patients with pulmonary hypertension and right heart failure will be at extraordinarily high risk and should have the need for surgery re-evaluated. (G)<\/jats:p><jats:p>\u2022 Perioperative glucose readings should be kept within 4\u201312 mmol\/l. (R)<\/jats:p><jats:p>\u2022 Patients with a high HbA1C facing urgent surgery should have their diabetes management assessed by a diabetes specialist. (G)<\/jats:p><jats:p>\u2022 Insulin-dependent diabetic patients must not omit insulin for more than one missed meal and will therefore require an insulin replacement regime. (R)<\/jats:p><jats:p>\u2022 Patients taking more than 5 mg of prednisolone daily should have steroid replacement in the peri-operative period. (R)<\/jats:p><jats:p>\u2022 Consider proton pump therapy for patients taking steroids in the peri-operative phase if they fit higher risk criteria. (R)<\/jats:p><jats:p>\u2022 Surgery within three months of stroke carries high risk of further stroke and should be delayed if possible. (R)<\/jats:p><jats:p>\u2022 Patients with rheumatoid arthritis should have flexion\/extension views assessed by a senior radiologist pre-operatively. (R)<\/jats:p><jats:p>\u2022 Patients at risk of post-operative cognitive dysfunction and delirium should be highlighted at pre-operative assessment. (G)<\/jats:p><jats:p>\u2022 Patients with Parkinson's disease (PD) must have enteral access so drugs can be given intra-operatively. Liaison with a specialist in PD is essential. (R)<\/jats:p><jats:p>\u2022 Intravenous iron should be considered for anaemia in the urgent head and neck cancer patient. (G)<\/jats:p><jats:p>\u2022 Preoperative blood transfusion should be avoided where possible. (R)<\/jats:p><jats:p>\u2022 Where pre-operative transfusion is essential it should be completed 24\u201348 hours pre-operatively. (R)<\/jats:p><jats:p>\u2022 An accurate alcohol intake assessment should be completed for all patients. (G)<\/jats:p><jats:p>\u2022 Patients considered to have a high level of alcohol dependency should be considered for active in-patient withdrawal at least 48 hours pre-operatively in liaison with relevant specialists. (R)<\/jats:p><jats:p>\u2022 Parenteral B vitamins should be given routinely on admission to alcohol-dependent patients. (R)<\/jats:p><jats:p>\u2022 Smoking cessation, commenced preferably six weeks before surgery, decreases the incidence of post-operative complications. (R)<\/jats:p><jats:p>\u2022 Antibiotics are necessary for clean-contaminated head and neck surgery, but unnecessary for clean surgery. (R)<\/jats:p><jats:p>\u2022 Antibiotics should be administered up to 60 minutes before skin incision, as close to the time of incision as possible. (R)<\/jats:p><jats:p>\u2022 Antibiotic regimes longer than 24 hours have no additional benefit in clean-contaminated head and neck surgery. (R)<\/jats:p><jats:p>\u2022 Repeat intra-operative antibiotic dosing should be considered for longer surgeries or where there is major blood loss. (R)<\/jats:p><jats:p>\u2022 Local antibiotic policies should be developed and adhered to due to local resistance patterns. (G)<\/jats:p><jats:p>\u2022 Individual assessment for venous thromboembolism (VTE) risk and bleeding risk should occur on admission and be reassessed throughout the patients' stay. (G)<\/jats:p><jats:p>\u2022 Mechanical prophylaxis for VTE is recommended for all patients with one or more risk factors for VTE. (R)<\/jats:p><jats:p>\u2022 Patients with additional risk factors of VTE and low bleeding risk should have low molecular weight heparin at prophylactic dose or unfractionated heparin if they have severe renal impairment. (R)<\/jats:p><\/jats:sec>","DOI":"10.1017\/s0022215116000372","type":"journal-article","created":{"date-parts":[[2016,5,12]],"date-time":"2016-05-12T10:37:06Z","timestamp":1463049426000},"page":"S13-S22","source":"Crossref","is-referenced-by-count":40,"title":["Pre-treatment clinical assessment in head and neck cancer: United Kingdom National Multidisciplinary Guidelines"],"prefix":"10.1017","volume":"130","author":[{"given":"A","family":"Robson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Sturman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"Williamson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"Conboy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Penney","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H","family":"Wood","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2016,5,12]]},"reference":[{"key":"S0022215116000372_ref7","unstructured":"Clinical indications for echocardiography. 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