ERAS for Free Fibula Flap Surgery: Effects on Postoperative Recovery and Complications

This study aimed to evaluate the effects of the enhanced recovery after surgery (ERAS) program on postoperative recovery of patients who underwent free fibula flap surgery.This retrospective study enrolled 188 patients who underwent free fibula flap surgery between January 2018 and December 2022; after propensity score matching, the ERAS and non-ERAS groups included 36 patients each. The primary outcome was the length of intensive care unit stay; the secondary outcomes were flap complications, unplanned reoperation, 30-day readmission, postoperative ventilator use length, surgical site infections, lower-limb comorbidities, and morbidity parameters.There were no significant differences in the demographic characteristics of the patients. However, the ERAS group showed lower length of intensive care unit stay (ERAS vs non-ERAS: 8.66 ± 3.90 days vs. 11.64 ± 5.42 days, P = 0.027) and post-operative ventilator use days (ERAS vs non-ERAS: 1.08 ± 0.28 days vs. 2.03 ± 1.05 days, P < 0.001). Other secondary outcomes were not significantly different between the two groups. Additionally, patients in the ERAS group had lower postoperative morbidity parameters, such as postoperative nausea, vomiting, urinary tract infections, and pulmonary complications ( P = 0.044).The ERAS program could be beneficial and safe for patients undergoing free fibula flap surgery, thereby improving their recovery and not increasing flap complications and 30-day readmission.