Lee Jui-Min, Chen Mei-Chun, Wu Szu-Hsien, Shih Yu-Chung, Lin Chih-Hsun, Hsiao Fu-Yin, Chen Chin-En, Chiu Yu-Jen, Wang Tien-Hsiang
Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan.
Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan; Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan.
J Plast Reconstr Aesthet Surg. 2025 May;104:7-13. doi: 10.1016/j.bjps.2025.02.020. Epub 2025 Feb 15.
Head and neck reconstruction is among the most expensive types of surgery, requiring long operation time and hospital stays, with high complication rates. Enhanced recovery after surgery improves the quality of post-operative recovery. In this study, we evaluated and compared the costs and outcomes in patients who underwent free flap reconstruction after head and neck cancer surgery with or without enhanced recovery. This retrospective study utilised an actively maintained prospective database. Patients who underwent head and neck surgery with free flap reconstruction between November 2020 and June 2023 were categorised into the enhanced recovery after surgery and control groups. The perioperative outcomes, complication rates and hospitalisation costs were analysed. Overall, 94 patients (47 per group) were included. Compared with the control group, the enhanced recovery after surgery group showed reduced duration of sedation (15.7 h vs 34.7 h, p<0.05), post-operative mechanical ventilation (36.6 h vs 63.7 h, p<0.05), intensive care unit stay (3.9 days vs 5.0 days, p<0.05) and earlier ambulation (7.5 days vs 8.9 days, p<0.05) without increased risks of minor or major complications. The median total costs per patient were $19,353.0 and $17,320.8 in the control and enhanced recovery after surgery groups, respectively. Implementing enhanced recovery after surgery resulted in a 10% reduction ($2167.8/person) in hospitalisation costs, mainly from decreased surgical and medication expenses. The enhanced recovery after surgery protocol is a safe, effective and cost-efficient programme that facilitates post-operative recovery in patients undergoing head and neck reconstruction without significantly increasing the risk of complications.
头颈部重建手术是最昂贵的手术类型之一，需要较长的手术时间和住院时间，且并发症发生率高。术后加速康复可提高术后恢复质量。在本研究中，我们评估并比较了头颈部癌症手术后接受游离皮瓣重建的患者在有或没有术后加速康复情况下的费用和结局。这项回顾性研究使用了一个积极维护的前瞻性数据库。2020年11月至2023年6月期间接受头颈部手术并进行游离皮瓣重建的患者被分为术后加速康复组和对照组。分析围手术期结局、并发症发生率和住院费用。总共纳入了94例患者（每组47例）。与对照组相比，术后加速康复组的镇静时间缩短（15.7小时对34.7小时，p<0.05）、术后机械通气时间缩短（36.6小时对63.7小时，p<0.05）、重症监护病房住院时间缩短（3.9天对5.0天，p<0.05）且更早下床活动（7.5天对8.9天，p<0.05），同时轻微或严重并发症风险未增加。对照组和术后加速康复组每位患者的总费用中位数分别为19,353.0美元和17,320.8美元。实施术后加速康复使住院费用降低了10%（每人2,167.8美元），主要是由于手术和药物费用减少。术后加速康复方案是一个安全、有效且具有成本效益的项目，可促进接受头颈部重建手术患者的术后恢复，而不会显著增加并发症风险。
