Comparison of the efficacy of Enhanced Recovery After Surgery (ERAS) protocol tailor-made for head and neck free flap oncosurgery with conventional perioperative care: A randomised clinical trial.

Abstract

Background and aims: Technological advances, accumulated experience, and evidence have made free-flap reconstruction [using the anterolateral thigh flap (ALT) and free fibular flap (FF)] for head and neck oncosurgical defects a routine procedure. This study aimed to assess the impact on recovery after head and neck oncosurgery by preoperative optimisation, intraoperative stress minimisation, and postoperative protocolised normalisation.

Methods: This randomised study included 60 adult patients undergoing head and neck oncosurgery with ALT/FF reconstruction, allocated to either the Enhanced Recovery After Surgery (ERAS) group (Group E) or the conventional care group (Group C). Our primary outcome measures were the length of hospital stay (LOS) and time to Return to Intended Oncologic Therapy (RIOT). Surgical intensive care unit (SICU) stay, serum lactate, creatinine, and opioid consumption comprised the secondary outcome measures. An independent sample t-test or Welch test was performed for continuous variables, and a Chi-square test was used for categorical variables.

Results: Mean LOS and time to RIOT [9.97 (standard deviation (SD): 2.19) and 34.6 (SD: 9.22) days] were significantly shorter in Group E versus Group C (10.97 (SD: 1.45) and 43.8 (SD: 20.89) days) (mean difference (MD): 1, 95% confidence interval (CI): 0.04, 1.96, P = 0.042, and MD: 9.2, 95% CI: 0.77, 17.63, P = 0.033, respectively). Mean pre-incisional, post-resection, and postoperative lactate levels were significantly lower in Group E versus Group C (P < 0.0001). Serum creatinine levels on the morning of surgery were significantly lower in Group E (P = 0.0225).

Conclusion: At least 90% compliance with the described 15-element ERAS protocol reduces LOS and time to RIOT in head-neck oncosurgery patients with free-flap reconstruction.