Background <p>The enhanced recovery after surgery (ERAS) program is a combined perioperative bundle designed to reduce perioperative stress. However, whether these programs are safe and effective for older patients who have undergone free-flap reconstruction for locally advanced oral cancers remains unclear. This study retrospectively evaluated the risk factors associated with delayed postoperative recovery and prolonged hospital length of stay (LOS) in older patients with locally advanced oral cancer who underwent resection and free-flap reconstruction from an ERAS perspective.</p> Methods <p>Sixty-one patients who underwent resection and free-flap reconstruction for locally advanced oral cancer were included. LOS, complications, nutritional intake, and mobilization were evaluated.</p> Results <p>The older group exhibited a longer LOS, delayed oral feeding, and more aspiration pneumonia than the non-older group. Analysis of older adults only revealed delayed oral feeding, not chronological age, as a risk factor for prolonged LOS.</p> Conclusions <p>Older patients were safely managed using ERAS; however, dysphagia may have interfered with the enhanced recovery.</p>