(0243) Perioperative Outcomes in Head and Neck Surgery Following Enhanced Recovery After Surgery Protocol Implementation

Introduction: Enhanced recovery after surgery (ERAS) protocols are multimodal care pathways designed to improve recovery rates after surgery. The current study compares outcomes in patients undergoing head and neck free flap reconstruction prior to and after implementation of a free flap-specific protocol.

Methods: A chart review of head and neck cancer patients diagnosed with squamous cell carcinoma who underwent free flap reconstruction at a tertiary referral academic institution (2010-2022) was conducted. Outcomes include complication rates, ED visits/hospital readmissions, all-cause mortality and length of stay. Outcomes were compared between type of reconstruction (osteocutaneous vs fasciocutaneous). Adherence to ERAS protocol was measured. Independent t-tests were used for continuous measures. Fisher’s Exact Test was used for categorical data.

Results: In total, 164 charts were reviewed (87 pre-protocol, 77 post-protocol). Of pre-protocol patients, 59% incurred non-wound related complications compared to 34% post-protocol (p = 0.0017). Of pre-protocol patients, 38% experienced wound complications compared to 17% of post-protocol (p = 0.0031). Total complications were less for the post-protocol compared to the pre-protocol group (67% and 43% respectively, p = 0.0028). There was no difference in one-year survival between groups (78.1% and 77.5%). Length of stay was significantly longer for the pre-protocol group (mean LOS 13.2 days pre-protocol and 11 days post-protocol, p = 0.025). No difference regarding number of ED visits or readmissions. Adherence to the protocol was significantly better in post-protocol group for multiple categories (perioperative antibiotic administration, limiting hypothermia, opioid sparing pain control, and early mobilization). Type of flap reconstruction (osteocutaneous versus fasciocutaneous) did not alter outcomes.

Conclusions: ERAS protocol implementation significantly decreases length of stay, wound complications, non-wound complications and composite complications after head and neck cancer resection and free flap reconstruction.