Enhanced recovery in patients having free tissue transfer for head and neck cancer: does it make a difference?

Programmes for Enhanced Recovery after Surgery (ERAS) accelerate recovery, reduce morbidity, and shorten hospital stay in a wide range of surgical specialties. We established a standardised multimodal ERAS pathway for patients who were being treated by free tissue transfer for head and neck cancer to evaluate its benefit. Our primary outcome was duration of hospital stay, and secondary outcomes included complications, number of days to first mobilisation, and readmission rates. We compared 100 consecutive patients who followed the ERAS programme with a control group of 40 consecutive patients who had free tissue transfer before the ERAS programme was introduced. There was a significantly reduced median duration of stay from 14 days in the control group to 10 days in the ERAS group. Patients in the ERAS group who were aged over 60 years, or had tracheostomies, or who required bone resection also had a significantly reduced duration of stay. There was no difference between morbidity and readmission rates, although patients in the ERAS group were mobilised significantly earlier. The ERAS programme is safe and effective for patients who are treated by free tissue transfer for head and neck cancer, and potentially reduces their duration of stay in hospital.