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Impact of Enhanced Recovery After Surgery Implementation on Hospital Recovery Metrics Following Head and Neck Free Flap Reconstruction
Carol Wang
*, You J. Park, Lamorna Coyle, Joseph Ricci
Plastic and Reconstructive Surgery, Northwell Health, New Hyde Park, NY
Purpose: Enhanced Recovery After Surgery (ERAS) pathways standardize perioperative care and improve postoperative outcomes in head and neck free flap reconstruction. This study evaluated hospital recovery metrics following ERAS implementation.
Methods: A retrospective cohort study was conducted on patients undergoing head and neck free flap reconstruction at a single institution from 2019-2023. Patients were classified into the control group (2019-2021) or the ERAS group (2022-2023). Baseline characteristics were compared. Primary outcomes included antibiotic duration, time to enteral and oral feeds, length of stay in the SICU and the hospital. Secondary outcomes included flap and medical complications. Variables were analyzed using Chi-Square tests and Mann-Whitney U Tests. Multivariable regression adjusted for ERAS status, ASA class, diabetes history, radiation history, and osteomyelitis/osteonecrosis (OM/ON).
Results: A total of 364 flaps were included (210 control, 154 ERAS), most commonly radial forearm (45.6%), fibula (29.1%), and anterolateral thigh free flaps (19.0%). The ERAS group had higher rates of diabetes and higher ASA classes (P<0.01), and lower OM/ON incidence (p<0.01). The ERAS group was associated with shorter antibiotic duration (4.5 vs 6.0 days), earlier oral feeding (5.0 vs 7.0 days), shorter SICU stay (3.8 vs 4.1 days), and reduced gastrostomy tube placement (11.7% vs 26.7%) (all p-values<0.05) (Table 1). There were no differences in flap outcomes, medical complications, or reoperation/re-admission rates. ERAS independently predicted decreased time to oral feeding (B=-0.24, p<0.01), while prior radiation predicted increased time (B=0.24, p<0.01). OM/ON independently predicted longer SICU stay (B=0.14, p<0.01) and antibiotic duration (B=0.13, p=0.01).
Conclusion: ERAS implementation in head and neck free flap reconstruction was associated with improved recovery metrics without increasing complications. Patients with prior radiation or OM/ON remain at risk for prolonged recovery.
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