BackgroundEnhanced recovery after surgery (ERAS) protocols have been demonstrated to expedite recovery and decrease hospital stay. While an ERAS protocol for head and neck cancer surgeries has been published1, there is limited research regarding its effectiveness. Even more limited or absent is published ERAS success specific to maxillofacial surgeries. This is relevant as previous studies have demonstrated a higher postoperative nausea and vomiting rate with maxillofacial surgeries compared to surgeries of the trunk or abdomen.2In July 2019, the Oral and Maxillofacial Surgery Department at Brooke Army Medical Center implemented an ERAS protocol for all patients undergoing orthognathic surgery. This retrospective study will compare various outcomes including postoperative pain, opioid requirements, and postoperative nausea and vomiting between subjects who underwent an ERAS protocol versus those who did not. MethodsA total of 56 patients were selected; 28 patients from 2019-2020 who had orthognathic surgery were enrolled into the ERAS protocol and were compared to 28 randomly selected patients from 2017-2018 who followed the previous non-ERAS protocol.Inclusion criteria included patients older than 18 years of age who underwent a Le Fort I osteotomy and/or mandibular osteotomy for orthognathic surgery. Patients who received other procedures in combination with orthognathic surgery were excluded. In the pre-operative holding unit, the ERAS group will need to have received the preoperative medications outlined below. Prior to the end of surgery, they will need to have been given liposomal bupivicaine. For the control group, the patients need to have not been given any of the following preoperative medications or liposomal bupivicaine. Both groups will need to have undergone a general anesthetic with a volatile agent. The ERAS protocol utilized is as followsprior to surgery: aprepitant 40mg, scopolamine patch 1.5mg, celecoxib 400mg, gabapentin 600 mg. Perioperativeacetaminophen 1000mg, ondansetron 4mg, dexamesathone 8mg, liposomal bupivacaine 5cc per quadrant. Postoperative analgesicsfirst-line ibuprofen 600mg, acetaminophen 1000mg, second-line tramadol 50mg, third-line oxycodone 5mg.Postoperative antiemetics: first-line ondansetron 4mg, second-line promethazine 12.5mg.The groups will be compared using standard methods. Categorical data will be summarized using percentages and analyzed using Chi-squared tests or Fisher's Exact test, whichever is most appropriate. Means and standard deviations or medians and inter-quartile ranges will be used as summary statistics for continuous variables, and they will be analyzed using Student's T-test or Wilcoxon's Kruskal Wallis Test, whichever most appropriate. Significance for results will be established when P-values are < .05, and the authors will report beta values/odds ratios and their 95% confidence intervals. ResultsIn total, 56 patients were retrospectively analyzed comparing the ERAS protocol to a non-ERAS protocol. A significant reduction in postoperative nausea and vomiting episodes, postoperative pain scores, and postoperative opioid use are associated with the ERAS group as well as secondary outcomes that will be discussed in the presentation. ConclusionERAS protocols have been shown to be predictable and effective in a variety of surgical specialties. These data suggest that an ERAS protocol with regards to orthognathic surgery is both predictable and effective in providing patients with improved post-surgical experiences. Additionally, ERAS protocol is not only applicable for orthognathic procedures but should be highly considered for other surgeries of the maxillofacial region.