{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T04:54:31Z","timestamp":1792644871532,"version":"4.5.0"},"reference-count":15,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2024,12,12]],"date-time":"2024-12-12T00:00:00Z","timestamp":1733961600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Enhanced recovery after surgery (ERAS) protocols are designed to improve postoperative outcomes. In this study, we compare outcomes for patients undergoing head and neck free flap surgery at a quaternary care institution before and after an ERAS protocol was implemented.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Retrospective study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Single quaternary care center.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective evaluation of outcomes from patients who underwent head and neck surgery with free flap reconstruction prior to ERAS (January 2018 to May 2022, baseline) with patient outcomes after implementation (June 2022 to September 2023, ERAS). Outcomes studied included length of stay (LOS), opioid utilization, postoperative emesis, readmission, and mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Patients in the ERAS group had significantly lower opioid utilization (206.84\u2009\u00b1\u2009217 morphine milligram equivalent vs 415.53\u2009\u00b1\u2009431, <jats:italic>P<\/jats:italic>\u2009&lt;\u2009.01) and significantly lower rates of postoperative emesis (1.74% vs 28.27%, <jats:italic>P<\/jats:italic>\u2009&lt;\u2009.01). This difference in emesis remained significant in the subgroup of patients who underwent total laryngectomy. The decreases in opioid use and emesis remained significant in multivariate analyses controlling for demographic factors and surgery type. We found no significant decrease in LOS or mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In the year after implementing an ERAS protocol for head and neck free flap surgery, we found significantly lower opioid utilization and the unique finding of lower postoperative emesis overall, including in the laryngectomy subgroup for whom emesis\u2010induced fistula is most impactful. No difference was noted in LOS or mortality. To our knowledge, this is the first study of an ERAS protocol for head and neck surgery to show a decrease in postoperative emesis.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ohn.1043","type":"journal-article","created":{"date-parts":[[2024,12,12]],"date-time":"2024-12-12T13:50:09Z","timestamp":1734011409000},"page":"846-852","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Decreased Postoperative Emesis and Opioid Use After Implementation of ERAS Protocol for Free Flap Surgery"],"prefix":"10.1002","volume":"172","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3233-7276","authenticated-orcid":false,"given":"Jesse K.","family":"Siegel","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Loyola University Medical Center Maywood Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7964-1390","authenticated-orcid":false,"given":"Kayeromi","family":"Gomez","sequence":"additional","affiliation":[{"name":"Clinical Research Office, Center for Translational Research and Education Loyola University Chicago Maywood Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0685-8107","authenticated-orcid":false,"given":"Carol","family":"Bier\u2010Laning","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Loyola University Medical Center Maywood Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,12,12]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2016.2981"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.28191"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-020-09174-2"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.28768"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjoms.2017.10.012"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2020.105117"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/coa.12482"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.4174\/astr.2019.97.5.239"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2019.11.009"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/2473974X20931037"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjoto.2020.102679"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0b013e31817e9d08"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2273.1996.tb01090.x"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2020.1170"},{"issue":"1","key":"e_1_2_8_16_1","first-page":"30","article-title":"Analgesic effects of preoperative gabapentin after tongue reconstruction with the anterolateral thigh flap","volume":"18","author":"Chiu TW","year":"2012","journal-title":"Hong Kong Med J"}],"container-title":["Otolaryngology\u2013Head and Neck Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ohn.1043","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T10:00:09Z","timestamp":1760954409000},"score":1,"resource":{"primary":{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/10.1002\/ohn.1043"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,12]]},"references-count":15,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,3]]}},"alternative-id":["10.1002\/ohn.1043"],"URL":"https:\/\/doi.org\/10.1002\/ohn.1043","archive":["Portico"],"relation":{},"ISSN":["0194-5998","1097-6817"],"issn-type":[{"value":"0194-5998","type":"print"},{"value":"1097-6817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,12]]},"assertion":[{"value":"2024-06-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-10-19","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-12-12","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}