ERAS has its origins in Colorectal surgery and has been rapidly adopted by multiple surgical fields to expedite patient recovery post-operatively. We have previously implemented ERAS protocols for head and neck surgery including laryngectomies and in Trans Oral Robotic Surgery. The aim of this study is to investigate the outcomes 4 years after implementation of an ERAS protocol in patients requiring surgical reconstruction with both soft tissue and bony flaps. Retrospective medical records review over a 4 year period (between April 2020 to April 2024) after implementation of ERAS protocol at a quaternary hospital in South Australia. We identified all patients requiring reconstructive flaps (both free flaps and pedicled) operated and managed in our institution. Our primary outcome measure was patient length of stay (LOS). Secondary outcomes included commencement of oral intake and removal of nasoenteric tube (NET), tracheostomy deccanulation and complication rates. Eighty eight patients over this four year period were managed with an ERAS protocol constructed by a multi –disciplinary team. For the entire cohort, the average of outcome measures were: LOS of 16 days (range 1-39 days), commencement of oral intake was 10 days (range 1-25 days), and removal of NET was 11 days (range 3-18 days). These outcomes were analysed in accordance to their various types of reconstructions. We present a fully implemented ERAS pathway for patients requiring reconstructive surgery with a 4 year retrospective analysis which identified significant positive influence on average patient length of stay in comparison to data in the current literature as other secondary outcomes. An analysis over this period of time allows for further refinement of protocols to better individualise patient care. The use of ERAS allows a streamlined, teamwork based approach to for clinicians, allied health and nursing staff with goal-orientated outcomes in the postoperative course