Outcomes of an enhanced recovery after surgery (ERAS) protocol following head and neck cancer surgery with free flap reconstruction.

The aim of this study was to evaluate the effectiveness of an enhanced recovery after surgery (ERAS) protocol following head and neck cancer (HNC) surgery with free flap reconstruction. Primary outcomes measured were length of stay (LOS), days to oral feeds, days to ambulation, complications within 1 month, and 30-day readmission. Secondary outcomes included days to urinary catheter removal (TOC), use and duration of patient-controlled analgesia (PCA), days to decannulation, and days to radiation therapy. Seventy-nine patients were studied: 37 ERAS and 42 pre-ERAS, with comparable baseline demographics. The ERAS group demonstrated significantly shorter median days to oral feeds (8.0 vs 11.0, P = 0.045) and TOC (5.0 vs 11.0, P = 0.007). Respiratory complications were also significantly lower in the ERAS group (0% vs 16.7%, P = 0.009). However, the ERAS group had longer median days to decannulation (8.0 vs 5.0, P < 0.001). No significant differences were observed in LOS, overall complication rate, or 30-day readmission. Adoption of the ERAS protocol in HNC free flap reconstruction is safe and effective, reducing time to oral feeding, respiratory complications, and days to TOC, though with longer decannulation times, without adversely affecting overall complications or readmissions.