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

Abstract

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%, P =.04) and postoperative (49.2% vs 27.2%, P =.026) blood transfusion, were more likely to be off vasopressors (98.3% vs 50.8%, P