Systematic Review of Patient Safety and Quality Improvement Initiatives in Breast Reconstruction

Abstract

Background: Improving patient care and safety requires high-quality evidence. The objective of this study was to systematically review the existing evidence for patient safety (PS) and quality improvement initiatives in breast reconstruction. Methods: A systematic review of the published plastic surgery literature was undertaken using a computerized search and following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Publication descriptors, methodological details, and results were extracted. Articles were assessed for methodological quality and clinical heterogeneity. Descriptive statistics were completed, and a meta-analysis was considered. Results: Forty-six studies were included. Most studies were retrospective (52.2%) and from the third level of evidence (60.9%). Overall, the scientific quality was moderate, with randomized controlled trials generally being higher quality. Studies investigating approaches to reduce seroma (28.3% of included articles) suggested a potential benefit of quilting sutures. Studies focusing on infection (26.1%) demonstrated potential benefits to prophylactic antibiotics and drain use under 21 days. Enhanced recovery after surgery protocols (10.9%) overall did not compromise PS and was beneficial in reducing opioid use and length of stay. Interventions to increase flap survival (10.9%) demonstrated a potential benefit of nitroglycerin on mastectomy skin flaps. Conclusions: Overall, studies were of moderate quality and investigated several worthwhile interventions. More validated, standardized outcome measures are required, and studies focusing on interventions to reduce thromboembolic events and bleeding risk could further improve PS.

An Interdisciplinary, Comprehensive Recovery Pathway Improves Microsurgical Breast Reconstruction Delivery

“…20 After initial introduction in 2015, the implementation of ERAS to breast reconstruction has likewise blossomed. 21,22 Meta-analyses on autologous reconstruction demonstrate ERAS protocols to significantly reduce inpatient opioid use and length of stay without difference in early complications. [21][22][23][24] Although rare reports describe discharge as early as postoperative day (POD) 1, the national norm is POD 3 to 4.…”

“…21,22 Meta-analyses on autologous reconstruction demonstrate ERAS protocols to significantly reduce inpatient opioid use and length of stay without difference in early complications. [21][22][23][24] Although rare reports describe discharge as early as postoperative day (POD) 1, the national norm is POD 3 to 4. 8,[25][26][27] Enhanced Recovery After Surgery has undoubtedly improved FFR, but offering a recovery course comparable to alloplastic approaches has remained a barrier to FFR adoption.…”

“…Enhanced Recovery After Surgery (ERAS) programs have gained rapid popularity, with successes in reducing hospital stay, morbidity, and complications 20 . After initial introduction in 2015, the implementation of ERAS to breast reconstruction has likewise blossomed 21,22 . Meta-analyses on autologous reconstruction demonstrate ERAS protocols to significantly reduce inpatient opioid use and length of stay without difference in early complications 21–24 .…”