Aims: Enhanced Recovery After Surgery (ERAS) protocols have demonstrated benefit across surgical specialties, however evidence in oncological head and neck free flap reconstruction remains limited. This study aimed to evaluate the impact of a standardised ERAS protocol on perioperative outcomes at a tertiary centre with over a decade of reconstructive head and neck surgery. Methodology: A retrospective cohort study was performed at the Royal Adelaide Hospital comparing outcomes before and after ERAS protocol implementation. Patients undergoing oncological head and neck free flap reconstruction were identified and stratified into Pre-ERAS (n=73) and Post-ERAS (n=110) cohorts. Primary outcome was length of stay (LOS). Secondary outcomes included time to tracheostomy decannulation, oral intake commencement, drain removal, and complication profile according to Clavien-Dindo classification. Mann-Whitney U test, Fisher’s exact test and Kaplan-Meier log-rank were employed for primary analysis (IBM SPSS v29; p<0.05). Results: 183 patients were included. LOS trended shorter Post-ERAS (median 14 vs 16 days) however did not reach statistical significance (p=0.168; log-rank p=0.616). Most notably, ERAS was associated with a 5-day earlier tracheostomy decannulation (p=0.002, r=−0.33) and 6-day earlier oral intake commencement (p<0.001). Clavien-Dindo complication profiles were comparable between cohorts. Compliance analysis identified lower overall adherence in osseous versus soft-tissue flap patients (57.7% vs 64.3%; p=0.009). Conclusion: ERAS implementation in head and neck free flap surgery is associated with significant acceleration in post-operative milestones and a trend towards shorter length of stay, without compromising safety. Compliance analysis identified a gap in osseous flap patients, supporting development of a tailored osseous-specific ERAS pathway moving forward.