Application of the concept of enhanced recovery after surgery in free flap repair of oral cancer patients

Objective To evaluate efficacy and safety of enhanced recovery after surgery in free flap repair of oral cancer patients. Methods In the Department of Oral and Maxillofacial Surgery of our hospital, 32 patients who received satisfaction survey before the implementation of ERAS scheme(from August 2018 to March 2019) were selected as the control group, and 32 patients after the implementation of ERAS scheme(from April 2019 to January 2020) were selected as the ERAS group. The control group was used conventional nursing care, and ERAS group was used perioperative nursing scheme for patients under enhanced recovery after surgery. The preoperative interventions include diversified health mission, nutritional screening, fitness training, and shortening the time of water fasting. Postoperative rehabilitation promotion includes multi-mode pre-analgesia, early feeding, early activity, early removal of urinary catheter, airway management, swallowing training, etc. Results The repeated measures ANOVA was used for the pain scores at 6, 24, 48 and 72 h after surgery. The difference between the time effect and the group effect was statistically significant(all P<0.01), and there was no interaction between the time effect and the group effect(F=1.157, P>0.05). The score of "pain" in the postoperative 6, 12, 48 and 72 h were compared between the two groups, there were statistically significant(all P<0.05). In ERAS group, the postoperative hospital stay was(16.72±2.13) days, the control group was(13.75±2.50) days, the average time was shortened by 3 days, the difference had statistical significance(t=5.113, P<0.01). The gastric tube indwelling time reduced by 2 days on average. The overall incidences of complications were significantly reduced, and the incidences of pulmonary infection, gastrointestinal reaction and pressure ulcer were statistically significant(all P<0.05). The incidence of skin flap crisis had no statistically significant difference(P>0.05). The satisfaction rate of patients in ERAS group was significantly improved, and the difference was statistically significant(P<0.05). Conclusion The perioperative ERAS nursing scheme for patients with oral cancer can reduce postoperative pain, reduce the incidence of complications, shorten the length of stay, and improve patient satisfaction. It is safe and effective in clinical application.