Objectives:
Head and neck reconstructive surgery is one of the costliest types of surgery which have the long operative times and hospital stays with high complication rates. This study was aimed to evaluate the impact of the ERAS protocols for patients undergoing free flap reconstruction after head and neck cancer resection at Taipei Veterans General Hospital.

Participants and Methods
All patients undergoing head and neck surgery with free flap reconstruction were prospectively enrolled in the ERAS protocol group since December 2020. A retrospective control group was selected from patients undergoing free flap reconstruction at our institution between 2020 to 2021 before our eras protocol have been established. Perioperative outcomes and complications, 30-day readmission rates, intensive care unit (ICU) and hospital length of stay, and costs of hospitalization were compared.

Results
Ninety-one patients were included in this study and divided into two group. Patients in the ERAS group start ambulation was earlier than Pre-ERAS group (7.5 vs 8.92 days, p=0.04). The ERAS group also significant reduced time to weaning ventilator (63.676 vs 36.559 hrs. p=0.005), sedation duration (34.68 vs 15.7 hrs. p=0.005), ICU Length of Stay (4.96 vs 3. 93 days, p=0.03) without increased risk of minor or major complication.

Conclusion
The ERAS Protocol for Head and Neck cancer with Free Flap Reconstruction in our institution can be a safety and effectiveness programs to reduced sedation duration, time to weaning ventilator, LOS in ICU and time to ambulation without significant increased risk of minor or major complications.