Compliance of existing institutional practice with ERAS protocol in patients with Head-Neck cancer undergoing free flap reconstruction surgery: A prospective cohort study

Head and neck malignancies require major free flap reconstruction surgeries to correct deformities and restore function. Optimal perioperative care is required for best possible recovery in this subset of patients. In this regard it has been established ERAS guidelines implementation decreases postoperative morbidity. In this prospective single center cohort study we have aimed to evaluate compliance percentage of the existing institutional practice with ERAS protocol in head and neck cancer patients undergoing free flap reconstruction surgery and to study the association between rates of ERAS compliance and post operative outcomes.

Compliance with the ERAS variables will be measured for each component of the program as enlisted by the ERAS society recommendations specific for free flap surgeries. Overall compliance will be calculated as the percentage of ERAS elements that are being fulfilled for each patient individually as well as for the entire cohort

The patients will then be divided into 2 groups according to their degree of compliance with the ERAS interventions. The patients who comply with 75% or more items will be allocated to the ERAS-Compliant group and those who comply with less than 75% of the ERAS components will be allocated to the ERAS- Noncompliant group. Complications reported within 30 days of surgery will be classified according to Clavien Dindo classification. The length of stay will be defined as the number of days patient spent in the hospital after surgery. Length of critical care unit stay will be defined as number of days patient stayed in the Intensive Care Unit and High Dependancy Unit after surgery. Surgical outcome measures will include re-exploration rates and negative re-exploration rates