Do Patient Expectations of Discharge Affect Length of Stay after Deep Inferior Epigastric Perforator Flap for Breast Reconstruction?

Abstract

Introduction Deep inferior epigastric artery perforator (DIEP) flap is a common method of breast reconstruction. Enhanced recovery after surgery (ERAS) postoperative protocols have been used to optimize patient outcomes and facilitate shorter hospital stays. The effect of patient expectations on length of stay (LOS) after DIEP has not been evaluated. The purpose of this study was to investigate whether patient expectations affect LOS. Methods A retrospective chart review was performed for patients undergoing DIEP flaps for breast reconstruction from 2017 to 2020. All patients were managed with the same ERAS protocol. Patients were divided in Group I (early expectations) and Group II (standard expectations). Group I patients had expectations set for discharge postoperative day (POD) 2 for unilateral DIEP and POD 3 for bilateral DIEP. Group II patients were given expectations for POD 3 to 4 for unilateral DIEP and POD 4 to 5 for bilateral. The primary outcome variable was LOS. Results The study included 215 DIEP flaps (45 unilateral and 85 bilateral). The average age was 49.8 years old, and the average body mass index (BMI) was 31.4. Group I (early expectations) included 56 patients (24 unilateral DIEPs, 32 bilateral). Group II (standard expectations) had 74 patients (21 unilateral, 53 bilateral). LOS for unilateral DIEP was 2.9 days for Group I compared with 3.7 days for Group II (p = 0.004). Group I bilateral DIEP patients had LOS of 3.5 days compared with 3.9 days for Group II (p = 0.02). Immediate timing of DIEP (Group I 42.9 vs. Group II 52.7%) and BMI (Group I 32.1 vs. Group II 30.8) were similar (p = 0.25). Conclusion Our study found significantly shorter hospital stay after DIEP flap for patients who expected an earlier discharge date despite similar patient characteristics and uniform ERAS protocol. Patient expectations should be considered during patient counseling and as a confounding variable when analyzing ERAS protocols.

The Safety of Same-day Discharge after Immediate Alloplastic Breast Reconstruction: A Systematic Review

“…Making sure the patient and surgeon are on the same page in terms of what is to be expected regarding the postoperative timeline and discharge may be the most important element of successful incorporation of ERAS. 43 , 44 The most common reasons why patients planned for same-day discharge end up staying overnight are delayed adoption of protocols or surgeon/patient preference. Complications were not a significant reason for unplanned overnight stays.…”

Enhanced Recovery after Surgery (ERAS) in DIEP-Flap Breast Reconstructions—A Comparison of Two Reconstructive Centers with and without ERAS-Protocol

“…This includes the preoperative information and the standardized, relatively short inpatient length of stay, which relieves patient’s anxiety. Here, the patient’s expectation is positively influenced so that they also perceive the procedure as a “simple” procedure [ 13 ].…”

Optimizing Unilateral Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Quality Improvement Study

“…Our work fits into the body of literature studying LOS after DIEP reconstruction. A 2022 article 25 examining the effects of patient expectations found that patients who expected to have a shorter postoperative stay after microvascular reconstruction indeed had a shorter LOS. These results are interesting in that they underscore the role of patient desires and thoughts on a postsurgical outcome.…”