Empowerment-Enhanced Perioperative Recovery Pathway After Jaw Cyst Enucleation: A Target Trial Emulation Using...

The authors evaluated whether an empowerment-enhanced perioperative recovery pathway was associated with early postoperative recovery after jaw cyst enucleation and whether disease cognition and anxiety mediated this association. This pragmatic target trial emulation (an observational design that mimics a randomized trial) included 134 patients treated between January 2024 and January 2025. Patients received usual care or the empowerment-enhanced pathway. Propensity-score overlap weighting (PSOW) was used to balance baseline covariates. The primary outcome was time to masticatory function recovery; secondary outcomes included symptom resolution, disease cognition, psychological distress, selected University of Washington Quality of Life (UW-QOL) domains, and complications. After PSOW, all standardized mean differences were <0.100. Compared with usual care, the empowerment-enhanced pathway shortened masticatory recovery by 1.46 days (95% CI: -1.67 to -1.25; P<0.001), pain disappearance by 1.06 days, swelling disappearance by 0.79 days, and recovery from restricted mouth opening by 2.14 days (all P<0.001). It also produced greater improvements in disease cognition, Hamilton Anxiety Rating Scale (HAMA) and Hamilton Depression Rating Scale (HAMD) scores, and selected UW-QOL domains. Weighted complication risk was lower with the pathway (3.17% versus 14.25%; adjusted risk difference, -11.08 percentage points; 95% CI: -20.13 to -2.03; P=0.016). Exploratory mediation analysis indicated that improved disease cognition and reduced anxiety jointly mediated 37.0% of the total effect on masticatory recovery. The pathway was associated with faster functional recovery, better psychological and patient-reported outcomes, and a lower complication risk after jaw cyst enucleation.