Enhanced Recovery After Surgery Pathways in Breast Reconstruction

Persing, Sarah; Manahan, Michele A.; Rosson, Gedge D.

doi:10.1016/j.cps.2019.12.002

Cited by 18 publications

(16 citation statements)

References 120 publications

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“…ERAS protocols have demonstrated ability to standardize postoperative stays and facilitate discharge. [12][13][14][15][16][17] Our study has exhibited the influence of patient expectation of discharge. We have shown that setting an expectation of a particular early discharge date can significantly affect the LOS.…”

Section: Discussionmentioning

confidence: 87%

“…In this study, patients who were discharged earlier had a similar complication rates to those had a standard discharge and no patients had flap loss Several studies have analyzed ERAS protocols for microvascular breast reconstruction and have found decreased postoperative narcotic use and LOS. [12][13][14][15][16][17]29 Batdorf et al found that in their ERAS cohort of 49 individuals, they were able to reduce LOS from 5.5 to 3.9 days. 13 Astanehe et al similarly published a study on ERAS protocols for microvascular breast reconstruction, finding that the LOS for their ERAS cohort was 4.8 days, compared with their traditional cohort's LOS of 6.6 days.…”

Section: Discussionmentioning

confidence: 98%

“…Future studies could focus on patient preference on hospital stay and if a reduced hospital stay leads to decreased satisfaction score. Although ERAS protocols and new surgical techniques have proven to reduce LOS, [12][13][14][15][16] there is still room for standardizing postoperative protocols. Despite having relatively small sample sizes, our study highlighted influence that plastic surgeons can have on the LOS for patients receiving DIEP flaps.…”

Section: Discussionmentioning

confidence: 99%

“…The implementation of enhanced recovery after surgery (ERAS) protocols has improved postoperative pain, minimized narcotics, and reduced LOS without increasing postoperative adverse effects. [12][13][14][15][16][17] The literature also shows that transversus abdominis plane (TAP) blocks reduce the level of narcotics that patients require to control their pain after abdominally based breast reconstruction. 18,19 Goals of DIEP flap postoperative protocols include enhanced patient outcomes, improved pain control with minimizing narcotics, and controlling costs with decreasing LOS.…”

mentioning

confidence: 99%

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

Bamba

Wiebe

Ingersol

et al. 2021

J Reconstr Microsurg

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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.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

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

Bamba

Wiebe

Ingersol

et al. 2021

J Reconstr Microsurg

View full text Add to dashboard Cite

show abstract

“…El BPV nuevamente aparece como el gold standard para el manejo del dolor de estas cirugías. El último metanálisis a la fecha (29), demostró que este disminuía el dolor agudo de reposo y dinámico dentro de las primeras 72 hrs, incluso en estudios en donde no se usaron infusiones continuas; además, se observó una disminución en el consumo de opioides y en las náuseas y vómitos post operatorios, y una disminución de la estancia hospitalaria, convirtiéndose así, en una herramienta primordial en los protocolos ERAS para cirugía mayor de mama (30,31). Este bloqueo también se ha estudiado en cirugías menores de mama (tumorectomías, mastectomías parciales) evidenciando una disminución del consumo de opioides y menor dolor post operatorio en comparación con anestesia general; pero para los autores, este es un bloqueo que no se justifica para este tipo de cirugía al estar asociado a una serie de complicaciones que si bien son escasas, pueden ser catastróficas (32).…”

Section: Cirugía De Mamaunclassified