Enhanced Recovery After Surgery (ERAS) pathways aim to optimise perioperative care by reducing surgical stress and improving postoperative recovery. Although ERAS protocols are widely implemented across several surgical specialties, evidence regarding their effectiveness in orthognathic surgery remains limited.

This retrospective cohort study evaluated the association between a structured ERAS protocol and perioperative outcomes in eighty patients undergoing bimaxillary orthognathic surgery at a single institution between January 2023 and December 2024. Patients were grouped according to the perioperative care pathway applied at the time of surgery (ERAS: n = 30; conventional care: n = 50). Outcomes included operative time, opioid consumption (morphine milligram equivalents, MME), intraoperative blood loss, patient-reported altered sensation (VAS) at 6 months, length of hospital stay (LOS), intraoperative fluid administration, and transfusion requirement.

The ERAS group demonstrated significantly shorter operative time (251.97 ± 88.74 vs 337.74 ± 77.26 min; p < 0.001), lower intraoperative blood loss (575.33 ± 227.24 vs 848.40 ± 532.08 mL; p = 0.003), reduced opioid consumption (8.83 ± 3.70 vs 11.86 ± 5.01 MME; p = 0.010), fewer transfusions (6.7%vs 26.0%; p = 0.040), and lower VAS scores for altered sensation (3.37 ± 1.73 vs 5.52 ± 2.61; p < 0.001). No significant differences were observed in LOS or intraoperative fluid administration.

Implementation of a structured ERAS protocol incorporating antioxidant supplementation was associated with improvements in several perioperative outcomes in orthognathic surgery. These findings support the clinical value of ERAS pathways and highlight the need for prospective studies to standardise protocol components for maxillofacial surgery.