A structured pathway for accelerated postoperative recovery reduces hospital stay and cost of care following microvascular breast reconstruction without increased complications. Issue 1 (January 2020)

• Record Type: Journal Article
• Authors: O'Neill, Anne C.; Mughal, Maleeha; Saggaf, Moaath M.; Wisniewski, Agnes; Zhong, Toni; Hofer, Stefan O.P.
• Is Part Of: Journal of plastic, reconstructive & aesthetic surgery. Volume 73:Issue 1(2020)
• Page Start: 19
• Page End: 26
• Publication Date: 2020-01
• Subjects: Breast Reconstruction -- Microsurgery -- Enhanced Recovery after Surgery -- Postoperative Complications; Surgery, Plastic -- Great Britain -- Periodicals; Reconstructive Surgical Procedures -- Periodicals; Surgery, Plastic -- Great Britain -- Periodicals; 617.9505
• DOI: 10.1016/j.bjps.2019.06.019
• Languages: English
• ISSNs: 1748-6815

Abstract

Summary: Introduction: Accelerated recovery protocols have proved effective in many surgical procedures but are infrequently applied in breast reconstruction. In this study, we evaluate the impact of a structured pathway for accelerated postoperative recovery in patients undergoing microvascular breast reconstruction at a high-volume center. Methods: We describe our care pathway for patients undergoing deep inferior epigastric artery perforator (DIEP) flap breast reconstruction at our center. We compared length of stay (LOS), complication rates, readmission rates, and cost of inpatient care before (pre-protocol (Pre-P)) and after (post-protocol (Post-P)) the implementation of the protocol. Results: Patients in the Post-P group ( n = 198) had a significant reduction in mean LOS as compared to those in the Pre-P ( n = 183) group (3.6 +/− 0.85 vs. 4.7 +/−1.04 days, p = 0.006). There was no significant difference in the rates of major (Pre-P 16.9% vs. Post-P 14.7%, p = 0.71) or minor (Pre-P 21.3% vs. 17.1%, p = 0.22) postoperative complications between groups. The readmission rates were also similar (Pre-P 6.5% vs. Post-P 4.5, p = 0.69). Implementation of the protocol resulted in a significant reduction in the mean cost of in-patient care. Conclusion: A simple protocol for accelerated and streamlined postoperative recovery effectively reduces LOS and patient care costs following DIEP flap breast reconstruction without compromising patient safety.