Enhanced Recovery After Surgery-Based Perioperative Protocol for Head and Neck Free Flap Reconstruction.

[OBJECTIVES] Evaluate an enhanced recovery after surgery (ERAS)-based free flap management protocol implemented at our center.

[STUDY DESIGN] Prospective cohort study of patients after implementation of an ERAS-based perioperative care protocol for patients undergoing free flap reconstruction of the head and neck as compared with a historical control group.

[SETTING] Tertiary care academic medical center.

[PARTICIPANTS AND METHODS] All patients undergoing free flap reconstruction were prospectively enrolled in the ERAS protocol group. A retrospective control group was identified by randomly selecting an equivalent number of patients from a records search of those undergoing free flap surgery between 2009 and 2015. Blood transfusion, complications, 30-day readmission rates, intensive care unit (ICU) and hospital length of stay, and costs of hospitalization were compared.

[RESULTS] Sixty-one patients were included in each group. Patients in the ERAS group underwent less frequent flap monitoring by physicians and had lower rates of intraoperative (70.5% vs 86.8%, = .04) and postoperative (49.2% vs 27.2%, = .026) blood transfusion, were more likely to be off vasopressors (98.3% vs 50.8%, < .01) and ventilator support (63.9% vs 9.8%, < .01) at the conclusion of surgery, and had shorter ICU stays (2.11 vs 3.39 days, = .017). Length of stay, readmissions, and complication rates did not significantly differ between groups.

[CONCLUSION] ERAS-based perioperative practices for head and neck free flap reconstruction can reduce time on the ventilator and in the ICU and the need for vasopressors, blood transfusions, and labor-intensive flap monitoring, without adverse effects on outcomes.