Evidence map›Paper›PMID 42484742›Full record

Observational studyInternational journal of clinical oncology2026

Financial and documentation-related workload impact of ERAS implementation in major head and neck surgery with free flap reconstruction under the Japanese DPC system.

Kohtaro Eguchi, Go Omura, Azusa Sakai, Toshihiko Sakai, Chihiro Fushimi, Takayuki Imai, Takeshi Shinozaki, Masami Mukai, Kazuto Matsuura, Seiichi Yoshimoto

Abstract readObservational Study
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In one paragraph

Observational study in International journal of clinical oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Kohtaro EguchiDepartment of Head and Neck Surgery, National Cancer Center Hospital, 5-1-1, Chuo-ku, Tokyo, 104-0045, Japan. koeguchi@ncc.go.jp.
Go OmuraDepartment of Head and Neck Surgery, National Cancer Center Hospital, 5-1-1, Chuo-ku, Tokyo, 104-0045, Japan.
Azusa SakaiDepartment of Head and Neck Surgery, National Cancer Center Hospital, 5-1-1, Chuo-ku, Tokyo, 104-0045, Japan.
Toshihiko SakaiDepartment of Head and Neck Surgery, National Cancer Center Hospital, 5-1-1, Chuo-ku, Tokyo, 104-0045, Japan.
Chihiro FushimiDepartment of Head and Neck Surgery, National Cancer Center Hospital, 5-1-1, Chuo-ku, Tokyo, 104-0045, Japan.
Takayuki ImaiDepartment of Head and Neck Surgery, Miyagi Cancer Center, 47-1 Nodayama, Medeshima-Shiote, Natori, Miyagi, 981-1293, Japan.
Takeshi ShinozakiDepartment of Head and Neck Surgery, National Cancer Center East Hospital, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
Masami MukaiDivision of Medical Informatics, National Cancer Center Hospital, 5-1-1, Chuo-ku, Tokyo, 104-0045, Japan.
Kazuto MatsuuraDepartment of Head and Neck Surgery, National Cancer Center East Hospital, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
Seiichi YoshimotoDepartment of Head and Neck Surgery, National Cancer Center Hospital, 5-1-1, Chuo-ku, Tokyo, 104-0045, Japan.

Funding

Japan Society for the Promotion of Science 25K20153the Japan Agency for Medical Research and Development (AMED) 21ck0106674the Japan Agency for Medical Research and Development (AMED) 24ck0106932
6 · The paper itself

Abstract

backgroundEnhanced recovery after surgery (ERAS) improves postoperative recovery in head and neck oncologic surgery. However, its institutional impact under the Japanese Diagnosis Procedure Combination (DPC) system, particularly regarding hospital revenue and frontline workload, remains unclear.

methodsThis retrospective cohort study included patients who underwent major resection of malignant head and neck tumors with free tissue transfer reconstruction at the National Cancer Center Hospital between April 2018 and March 2022. Patients were classified into pre-ERAS and post-ERAS groups according to implementation of the PreSte ERAS protocol in May 2020. Financial outcomes included DPC revenue, fee-for-service revenue, total hospital revenue, and revenue efficiency defined as revenue per hospital day. Frontline workload was assessed using the total number of characters documented in electronic medical records by non-physician healthcare professionals.

resultsA total of 310 patients were analyzed (155 per group). Median length of stay decreased after ERAS implementation (25 vs. 23 days; p = 0.002). Total revenue showed a non-significant decreasing trend after ERAS implementation (109,360 vs. 98,626 points; p = 0.104). Revenue efficiency increased after ERAS implementation (3627 vs. 3984 points per hospital day; p < 0.001). Documentation volume tended to increase but did not differ significantly overall. Sensitivity analysis excluding free fibula flap reconstruction showed consistent results.

conclusionERAS implementation was associated with shorter hospitalization and improved revenue efficiency under the Japanese DPC-based system. Although total revenue did not increase, and an increased multidisciplinary workload cannot be excluded, these findings support the potential institutional feasibility of ERAS.

Indexed as

Free Tissue FlapsHead and Neck NeoplasmsPlastic Surgery ProceduresWorkloadAgedDocumentationFemaleHumansJapanLength of StayMaleMiddle AgedRetrospective StudiesEnhanced recovery after surgeryERASFree flap reconstructionHead and neck cancerMultidisciplinary approach

Identifiers

PMID42484742

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.