Cost analysis and clinical outcomes of enhanced recovery after surgery for head and neck free flap reconstruction

Abstract

Head and neck reconstruction is among the most expensive types of surgery, requiring long operation time and hospital stays, with high complication rates. Enhanced recovery after surgery improves the quality of post-operative recovery. In this study, we evaluated and compared the costs and outcomes in patients who underwent free flap reconstruction after head and neck cancer surgery with or without enhanced recovery. This retrospective study utilised an actively maintained prospective database. Patients who underwent head and neck surgery with free flap reconstruction between November 2020 and June 2023 were categorised into the enhanced recovery after surgery and control groups. The perioperative outcomes, complication rates and hospitalisation costs were analysed. Overall, 94 patients (47 per group) were included. Compared with the control group, the enhanced recovery after surgery group showed reduced duration of sedation (15.7 h vs 34.7 h, p<0.05), post-operative mechanical ventilation (36.6 h vs 63.7 h, p<0.05), intensive care unit stay (3.9 days vs 5.0 days, p<0.05) and earlier ambulation (7.5 days vs 8.9 days, p<0.05) without increased risks of minor or major complications. The median total costs per patient were $19,353.0 and $17,320.8 in the control and enhanced recovery after surgery groups, respectively. Implementing enhanced recovery after surgery resulted in a 10% reduction ($2167.8/person) in hospitalisation costs, mainly from decreased surgical and medication expenses. The enhanced recovery after surgery protocol is a safe, effective and cost-efficient programme that facilitates post-operative recovery in patients undergoing head and neck reconstruction without significantly increasing the risk of complications.