National Trends in Length of Stay for Microvascular Breast Reconstruction: An Evaluation of 10,465 Cases Using the American College of Surgeons National Surgical Quality Improvement Program Database

Holoyda, Kathleen A.; Magno-Padron, David; Carter, Gentry; Agarwal, Jay P.; Kwok, Alvin C.

doi:10.1097/prs.0000000000008706

Cited by 10 publications

(12 citation statements)

References 33 publications

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“…19 A group that performed a national analysis of breast free-flap reconstruction patients similarly noted a decrease in LOS from 4.47 to 3.90 days during the years of 2012 to 2018. 20 Meanwhile, our study, and the work of Jablonka et al 14 and Baltodano et al 17 support discharge on POD 2 without an increase in flap or patient complications. Jablonka et al 14 showed that the implementation of ERAS protocols could reduce LOS to as low as 2-3 days while maintaining a complication rate of 8.7% with a failure rate of 2.2%.…”

Section: Discussionsupporting

confidence: 70%

“…The majority of articles that detail ERAS protocols have described successful discharge after DIEP breast free-flap reconstruction on POD 3, such as DelMauro et al 18 who reported average LOS as 3.26 ± 1.19 days and Bonde et al 19 who reported a significant reduction in LOS of 3.6 ± 0.85 from 4.7 ±1.04 days 19 . A group that performed a national analysis of breast free-flap reconstruction patients similarly noted a decrease in LOS from 4.47 to 3.90 days during the years of 2012 to 2018 20 . Meanwhile, our study, and the work of Jablonka et al 14 and Baltodano et al 17 support discharge on POD 2 without an increase in flap or patient complications.…”

Section: Discussionmentioning

confidence: 97%

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Significant Reduction in Length of Stay in Deep Inferior Epigastric Perforator Flap Breast Reconstruction With Implementation of Multimodal ERAS Protocol

et al. 2023

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Background Enhanced Recovery After Surgery (ERAS) implementation achieves earlier recovery, reduced hospital length of stay (LOS) and improved outcomes in patients undergoing deep inferior epigastric perforator (DIEP) free flaps. We sought to review our ERAS protocols and their impact on our patients' LOS compared with the literature. Methods This was a retrospective review of a single surgeon's experience from 2017 to 2021 of patients undergoing DIEP free-flap breast reconstruction with LOS as the primary outcome. Complication rates and patient demographics are described as secondary outcomes. Results One hundred twenty-one patients underwent DIEP free-flap breast reconstruction. After adapting ERAS protocols, there has been a 0.98 [SD, 0.17; confidence interval [CI], −1.3 to −0.64; P < 0.001) day decrease in length of stay comparing pre-ERAS to post-ERAS implementation. Length of stay has routinely decreased from an average discharge on day 4.17 (SD, 1.1; range, 3–8 days) in 2017 to discharge on day 2.91 (SD, 1.1; range, 1–5 days) in 2021. Seventy-five percent of patients in 2021 were hospitalized for 3 or fewer days compared with 75% of patients in 2017 hospitalized for 4 or more days. One patient experienced a flap failure. Our study supports successful discharge on postoperative days 2–3 compared with postoperative days 3–4 in the current literature. Conclusions The implementation of our ERAS protocol for DIEP free-flap breast reconstruction has resulted in a shorter LOS compared with contemporary literature. The ERAS protocols can be efficiently adopted in microsurgical DIEP breast reconstruction to achieve a shorter LOS without jeopardizing patient outcomes.

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 97%

Significant Reduction in Length of Stay in Deep Inferior Epigastric Perforator Flap Breast Reconstruction With Implementation of Multimodal ERAS Protocol

et al. 2023

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“…The reduced LOS trend was also seen from the American College of Surgeons National Database, where LOS after unilateral reconstructions decreased from 4.47 days in 2012 to 3.9 days in 2018 [ 21 ]. In a single center cohort study from the Netherlands, ERAS reduced the LOS from 6.2 to 5 days [ 14 ].…”

Section: Discussionmentioning

confidence: 92%

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

Linder

Walle

Loucas

et al. 2022

JPM

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Enhanced recovery after surgery (ERAS) is established for autologous breast reconstruction. ERAS leads to a shortened hospital stay and improved outcome after elective surgery. In this retrospective, two-center case–control study, we compared two different treatment regimens for patients undergoing a DIEP-flap breast reconstruction from two centers, one with an established ERAS protocol and one without. All patients with DIEP breast reconstructions over the period of 12 months were included. The primary outcome measure was the length of hospital stay (LOS) in days. A total of 79 patients with 95 DIEP-flaps were analyzed. In group A (ERAS) 42 patients were operated with DIEP flaps, in group B (non-ERAS) 37 patients. LOS was significantly reduced in the ERAS group (4.51 days) compared to the non-ERAS group (6.32; p < 0.001). Multivariate analysis showed that, in group A, LOS is significantly affected by surgery duration. BMI in the ERAS group had no effect on LOS. In group B a higher BMI resulted in a significantly higher LOS. In multivariate analysis, neither age nor type for surgery (primary/secondary/after neoadjuvant therapy, etc.) affected LOS. In both groups, no systemic or flap-related complications were observed. Comparing two reconstructive centers with and without implemented ERAS, ERAS led to a significantly decreased LOS for all patients. ERAS implementation does not result in an increased complication rate or flap loss. Postoperative pain can be well managed with basic analgesia using NSAID when intraoperative blocks are applied. The reduced use of opioids was well tolerated. With implementation of ERAS the recovery experience can be enhanced making autologous breast reconstructions more available and attractive for various patients.

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“…Meanwhile, the absolute number of hospital days in the current study seems to be longer than that for microvascular breast reconstruction in the United States. According to Holoyda et al ( 22 ), the mean length of hospital stay in the U.S. was 3.90 days in 2018. However, a direct comparison of hospital stays between two countries with different healthcare systems is not appropriate.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes following robotic versus conventional DIEP flap in breast reconstruction: A retrospective matched study

et al. 2022

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BackgroundA robotic deep inferior epigastric perforator (DIEP) flap created through a totally extraperitoneal approach minimizes violation of the donor site, which may lead to postoperative pain reduction and rapid recovery. The authors compared the clinical outcomes of robotic and conventional DIEP flap breast reconstructions.MethodsData from consecutive patients who underwent mastectomy with DIEP flaps for breast reconstruction between July 2017 and January 2021 were retrospectively reviewed. Patients were divided into robotic and conventional DIEP groups, and the two groups were matched using the inverse probability of treatment weighting method. They were compared based on the reconstruction time, drainage amount, postoperative pain, rescue analgesics, hospital stay, complications, and BREAST-Q scores.ResultsAfter matching, a dataset of 207 patients was formed, including 21 patients in the robotic DIEP group and 186 patients in the conventional DIEP group. The mean reconstruction time was longer in the robotic DIEP group than in the conventional DIEP group (P<0.001). In the robotic group, pain intensity during the postoperative 6–24 hours was significantly reduced (P=0.001) with less use of fentanyl (P=0.003) compared to the conventional DIEP group. The mean length of hospital stay for the robotic DIEP group was shorter than that for conventional DIEP (P=0.002). BREAST-Q scores indicated a higher level of the abdominal physical well-being domain in the robotic group (P=0.020). Complication rates were comparable between the two groups.ConclusionsThis study suggests that a robotic DIEP flap offers enhanced postoperative recovery, accompanied by a reduction in postoperative pain and hospital stay.

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National Trends in Length of Stay for Microvascular Breast Reconstruction: An Evaluation of 10,465 Cases Using the American College of Surgeons National Surgical Quality Improvement Program Database

Cited by 10 publications

References 33 publications

Significant Reduction in Length of Stay in Deep Inferior Epigastric Perforator Flap Breast Reconstruction With Implementation of Multimodal ERAS Protocol

Significant Reduction in Length of Stay in Deep Inferior Epigastric Perforator Flap Breast Reconstruction With Implementation of Multimodal ERAS Protocol

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

Clinical outcomes following robotic versus conventional DIEP flap in breast reconstruction: A retrospective matched study

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