The impact of enhanced recovery after surgery nursing on the prognosis of patients undergoing head and neck free flap transplantation: a meta-analysis

doi:10.19438/j.cjoms.2026.03.016

Abstract

Abstract: PURPOSE: To systematically evaluate the impact of enhanced recovery after surgery(ERAS) nursing on the prognosis of patients after head and neck free flap transplantation, and to provide evidence-based basis for optimizing clinical nursing plans. METHODS: Databases including CNKI, Wanfang Data, VIP, CBM, PubMed, Embase, Web of Science, CINAHL, and Cochrane Library were systematically searched from inception to April 1, 2025. Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) comparing ERAS nursing with conventional nursing were included. Meta-analysis was performed using RevMan 5.4 software. RESULTS: A total of 11 studies involving 902 patients were included. Meta-analysis showed that ERAS nursing significantly reduced the risk of flap necrosis [RR=0.20, 95%CI (0.08, 0.51), P=0.0008], pressure injury incidence [RR=0.28, 95%CI (0.11, 0.71), P=0.008], relieved anxiety [SMD=-1.95, 95%CI (-3.10, -0.81), P=0.0008], alleviated postoperative pain [SMD=-1.16, 95%CI(-1.48, -0.83), P<0.00001], and shortened total hospital stay [SMD=-1.56, 95%CI (-2.18, -0.94), Z=4.95, P<0.00001]. However, there were no significant differences between ERAS nursing and conventional nursing in the incidence of vascular crisis [RR=0.74, 95%CI (0.31, 1.75), P=0.49], pulmonary infection [RR=0.40, 95%CI (0.16, 1.01), P=0.05], and wound infection [RR=0.54, 95%CI (0.29, 1.03), P=0.06]. CONCLUSIONS: ERAS nursing does not affect flap safety after head and neck free flap transplantation, and can effectively reduce the risk of pressure injury, shorten hospital stay, and relieve anxiety and pain. However, it has no obvious advantages in preventing pulmonary infection and wound infection, and more high-quality studies are needed for further verification.

Key words: Enhanced recovery after surgery, Free flap transplantation, Head and neck tumors, Meta-analysis, Prognosis

CLC Number:

R782.2
R493

Wang Na, Ni Xiaowei, Zhao Wenbo. The impact of enhanced recovery after surgery nursing on the prognosis of patients undergoing head and neck free flap transplantation: a meta-analysis[J]. China Journal of Oral and Maxillofacial Surgery, 2026, 24(3): 308-316.

References

[1] Tsai CH, Yang C, Liu YC, et al.Risk factors of free flap outcomes after head and neck cancer surgery: a multivariable analysis from a single center experience[J]. Microsurgery, 2025, 45(2): e70023.
[2] Langdell HC, Shammas RL, Atia A, et al.Vein grafts in free flap reconstruction: review of indications and institutional pearls[J]. Plast Reconstr Surg, 2022, 149(3): 742-749.
[3] 赵志强, 牛洪华, 徐静磊. 组合股前外侧穿支皮瓣在四肢大面积不规则创面修复中的应用[J].实用手外科杂志, 2024, 38(4): 482-486.
Zhao ZQ, Niu HH, Xu JL.Application of combined anterolateral thigh perforator flaps in the repair of large-area irregular wounds of the extremities[J]. Journal of Practical Hand Surgery, 2024, 38(4): 482-486.
[4] Parsemain A, Philouze P, Pradat P, et al.Free flap head and neck reconstruction: feasibility in older patients[J]. J Geriatr Oncol, 2019, 10(4): 577-583.
[5] Liu S, Zhang WB, Yu Y, et al.Free flap transfer for pediatric head and neck reconstruction: what factors influence flap survival?[J]. Laryngoscope, 2019, 129(8): 1915-1921.
[6] Pu LLQ.Free flaps in lower extremity reconstruction[J]. Clin Plast Surg, 2021, 48(2): 201-214.
[7] Soteropulos CE, Chen JT, Poore SO, et al.Postoperative management of lower extremity free tissue transfer: a systematic review[J]. J Reconstr Microsurg, 2019, 35(1): 1-7.
[8] 乔晓娟, 杨国平. 基于Orem自理理论的分阶段护理对口腔颌面部游离皮瓣移植术患者的影响[J].医药前沿, 2025, 15(8): 92-94, 98.
Qiao XJ, Yang GP.Impact of phased nursing based on Orem's self-care theory on patients undergoing oral and maxillofacial free flap transplantation[J]. Journal of Frontiers of Medicine, 2025, 15(8): 92-94,98.
[9] 韩丽丽, 黄嘉玲, 陈芳, 等. 加速康复外科护理在头颈部肿瘤患者围手术期中的应用[J].中国卫生标准管理, 2025, 16(6): 180-184.
Han LL, Huang JL, Chen F, et al.Application of enhanced recovery after surgery (ERAS) nursing in the perioperative period of patients with head and neck tumors[J]. China Health Standard Management, 2025, 16(6): 180-184.
[10] 房玉霞, 周婷婷, 关银银. 集束化干预策略对断指再植术后患者舒适度的影响[J]. 中华显微外科杂志, 2018, 41(6): 603-605.
Fang YX, Zhou TT, Guan YY.Impact of bundled intervention strategies on postoperative comfort in patients undergoing finger replantation[J]. Chinese Journal of Microsurgery, 2018, 41(6): 603-605.
[11] 韩玉敏. 游离复合组织瓣血管化移植术后血管危象和体位舒适度的观察[D].青岛:青岛大学, 2016.
HAN YM.Observation of vascular crisis and postural comfort after vascularized transplantation of free composite tissue flaps[D]. Qingdao: Qingdao University, 2016.
[12] Kim M, Wu MP, Miller LE, et al.Early weight-bearing after fibula free flap surgery[J]. JAMA Otolaryngol Head Neck Surg, 2024, 150(2): 127-132.
[13] 董晓琪, 叶国凤, 邵丽红. 口底癌伴血小板增多症行肿瘤切除加游离皮瓣移植患者的护理[J].护理与康复, 2024, 23(9): 76-78.
Dong XQ, Ye GF, Shao LH.Nursing care of patients with floor of mouth cancer complicated with thrombocytosis undergoing tumor resection combined with free flap transplantation[J]. Journal of Nursing and Rehabilitation, 2024, 23(9): 76-78.
[14] 李艳君. 股前外侧穿支皮瓣修复口腔癌患者护理中快速康复外科的应用价值分析[J]. 中国药物与临床, 2021, 21(8): 1414-1416.
Li YJ.Analysis of the application value of enhanced recovery after surgery (ERAS) in the nursing care of oral cancer patients undergoing anterolateral thigh perforator flap repair[J]. Chinese Remedies & Clinics, 2021, 21(8): 1414-1416.
[15] 龚玲,李哲臻,刘梅,等.加速康复外科护理对口腔癌手术患者的影响[J].中外医学研究, 2023, 21(22): 110-113.
Gong L, Li ZZ, Liu M, et al.Influence of enhanced recovery after surgery (ERAS) nursing on patients undergoing oral cancer surgery[J]. Chinese and Foreign Medical Research, 2023, 21(22): 110-113.
[16] 徐志慧. 加速康复外科护理理念对口腔癌行皮瓣移植术后患者营养状况和康复情况的影响[J].中国医药科学, 2022, 12(4): 115-118, 145.
Xu ZH.Influence of enhanced recovery after surgery (ERAS) nursing concept on nutritional status and rehabilitation of patients undergoing flap transplantation for oral cancer[J]. China Medicine and Pharmacy, 2022, 12(4): 115-118, 145.
[17] 仇雄文, 曾碰华, 杨宇. 加速康复外科护理在游离组织瓣移植修复面部缺损围手术期中的应用[J].中国医疗美容, 2022, 12(1): 72-76.
Qiu XW, Zeng PH, Yang Y.Application of enhanced recovery after surgery (ERAS) nursing in the perioperative period of free tissue flap transplantation for facial defect repair[J]. China Medical Cosmetology, 2022, 12(1): 72-76.
[18] 陈敏. 加速康复外科理念在口腔颌面部游离皮瓣移植术患者围术期护理中的应用[J].齐鲁护理杂志, 2019, 25(14): 73-75.
Chen M.Application of enhanced recovery after surgery(ERAS) concept in perioperative nursing of patients undergoing free flap transplantation in oral and maxillofacial region[J]. Journal of Qilu Nursing, 2019, 25(14): 73-75.
[19] 刘璐璐, 李秀川, 袁冯, 等. 加速康复外科理念在游离皮瓣修复口腔癌患者中的应用[J].中华全科医学, 2020, 18(10): 1774-1778.
Liu LL, Li XC, Yuan F, et al.Application of enhanced recovery after surgery (ERAS) concept in free flap repair for oral cancer patients[J]. Chinese Journal of General Practice, 2020, 18(10): 1774-1778.
[20] 储冬吟, 吴叶荣. 加速康复外科在口腔癌行皮瓣移植术后患者护理中的应用[J].中国药物与临床, 2020, 20(16): 2826-2828.
Chu DY, Wu YR.Application of enhanced recovery after surgery (ERAS) in nursing care of patients undergoing flap transplantation for oral cancer[J]. Chinese Remedies & Clinics, 2020, 20(16): 2826-2828.
[21] 兰晓炜, 林燕, 谢娟. 快速康复外科护理在口腔颌面部肿瘤术后游离皮瓣移植修复患者中的应用[J].中国医疗美容, 2024, 14(10): 68-71.
Lan XW, Lin Y, Xie J.Application of fast- track surgery nursing in patients undergoing free flap transplantation for repair after oral and maxillofacial tumor surgery[J]. China Medical Cosmetology, 2024, 14(10): 68-71.
[22] 廖雅君. 快速康复外科在股前外侧穿支皮瓣修复口腔癌患者护理中的应用[J].医学食疗与健康, 2020, 18(9): 108-109.
Liao YJ.Application of fast-track surgery in nursing care of oral cancer patients undergoing anterolateral thigh perforator flap repair[J]. Medical Diet and Health, 2020, 18(9): 108-109.
[23] Frenkel CH, Donahue EE, Cochran A, et al.The impact of an enhanced recovery after surgery protocol for major head and neck oncologic surgery on postoperative complications and adjuvant treatment delivery[J]. Head Neck, 2025, 47(1): 68-80.
[24] Lee JM, Chen MC, Wu SH, et al.Cost analysis and clinical outcomes of enhanced recovery after surgery for head and neck free flap reconstruction[J]. J Plast Reconstr Aesthet Surg, 2025,104: 7-13.
[25] Tufanaru C, Munn Z, Stephenson M, et al.Fixed or random effects meta-analysis? common methodological issues in systematic reviews of effectiveness[J]. Int J Evid Based Healthc, 2015, 13(3): 196-207.
[26] Sievert M, Goncalves M, Tamse R, et al.Postoperative management of antithrombotic medication in microvascular head and neck reconstruction: a comparative analysis of unfractionated and low-molecular-weight heparin[J]. Eur Arch Otorhinolaryngol, 2021, 278(5): 1567-1575.
[27] Liu S, Zhang WB, Yu Y, et al.Free flap transfer for pediatric head andneck reconstruction: what factors influence flap survival?[J].Laryngoscope, 2019, 129(8): 1915-1921.
[28] Denis B, Gourbeix C, Coninckx M, et al.Maxillofacial free flap surgery outcomes in critical care: a single-center investigation looking for clues to improvement[J]. Perioper Med (Lond), 2022, 11(1): 11.
[29] Lusquinhos J, Tavares M, Abelha F.Postoperative pulmonary complications and perioperative strategies: a systematic review[J]. Cureus, 2023, 15(5): e38786.
[30] Nason KS.Acute intraoperative pulmonary aspiration[J]. Thorac Surg Clin, 2015, 25(3): 301-307.
[31] Petrar S, Bartlett C, Hart RD, et al.Pulmonary complications after major head and neck surgery: a retrospective cohort study[J].Laryngoscope, 2012, 122(5): 1057-1061.
[32] BuSaba NY, Schaumberg DA. Predictors of prolonged length of stay after major elective head and neck surgery[J]. Laryngoscope, 2007, 117(10): 1756-1763.
[33] Petrar S, Bartlett C, Hart RD, et al.Pulmonary complications after major head and neck surgery: a retrospective cohort study[J].Laryngoscope, 2012, 122(5): 1057-1061.
[34] 于晓凤, 李娇, 陈欧, 等. 完全断指再植术后缩短患者卧床时间的干预性研究[J]. 中华显微外科杂志, 2024, 47(1): 93-97.
Yu XF, Li J, Chen O, et al.Interventional study on shortening the bed-rest time of patients after complete digital replantation[J]. Chinese Journal of Microsurgery, 2024, 47(1): 93-97.