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Enhanced Recovery after Surgery Protocol Decreases Length of Stay and Postoperative Narcotic Use in Microvascular Breast Reconstruction.
Muetterties, Corbin E; Taylor, Jeremiah M; Kaeding, Diana E; Morales, Ricardo R; Nguyen, Anissa V; Kwan, Lorna; Tseng, Charles Y; Delong, Michael R; Festekjian, Jaco H.
Afiliação
  • Muetterties CE; From the Division of Plastic Surgery, University of California Los Angeles, Los Angeles, Calif.
  • Taylor JM; From the Division of Plastic Surgery, University of California Los Angeles, Los Angeles, Calif.
  • Kaeding DE; From the Division of Plastic Surgery, University of California Los Angeles, Los Angeles, Calif.
  • Morales RR; From the Division of Plastic Surgery, University of California Los Angeles, Los Angeles, Calif.
  • Nguyen AV; From the Division of Plastic Surgery, University of California Los Angeles, Los Angeles, Calif.
  • Kwan L; Department of Urology, University of California Los Angeles, Los Angeles, Calif.
  • Tseng CY; From the Division of Plastic Surgery, University of California Los Angeles, Los Angeles, Calif.
  • Delong MR; Department of Urology, University of California Los Angeles, Los Angeles, Calif.
  • Festekjian JH; From the Division of Plastic Surgery, University of California Los Angeles, Los Angeles, Calif.
Plast Reconstr Surg Glob Open ; 11(12): e5444, 2023 Dec.
Article em En | MEDLINE | ID: mdl-38098953
ABSTRACT

Background:

Enhanced recovery after surgery (ERAS) protocols have demonstrated efficacy following microvascular breast reconstruction. This study assesses the impact of an ERAS protocol following microvascular breast reconstruction at a high-volume center.

Methods:

The ERAS protocol introduced preoperative counseling, multimodal analgesia, early diet resumption, and early mobilization to our microvascular breast reconstruction procedures. Data, including length of stay, body mass index, inpatient narcotic use, outpatient narcotic prescriptions, inpatient pain scores, and complications, were prospectively collected for all patients undergoing microvascular breast reconstruction between April 2019 and July 2021. Traditional pathway patients who underwent reconstruction immediately before ERAS implementation were retrospectively reviewed as controls.

Results:

The study included 200 patients, 99 in traditional versus 101 in ERAS. Groups were similar in body mass index, age (median age traditional, 54.0 versus ERAS, 50.0) and bilateral reconstruction rates (59.6% versus 61.4%). ERAS patients had significantly shorter lengths of stay, with 96.0% being discharged by postoperative day (POD) 3, and 88.9% of the traditional cohort were discharged on POD 4 (P < 0.0001). Inpatient milligram morphine equivalents (MMEs) were smaller by 54.3% in the ERAS cohort (median MME 154.2 versus 70.4, P < 0.0001). Additionally, ERAS patients were prescribed significantly fewer narcotics upon discharge (median MME 337.5 versus 150.0, P < 0.0001). ERAS had a lower pain average on POD 0-3; however, this finding was not statistically significant.

Conclusion:

Implementing an ERAS protocol at a high-volume microvascular breast reconstruction center reduced length of stay and postoperative narcotic usage, without increasing pain or perioperative complications.

Texto completo: 1 Base de dados: MEDLINE Idioma: En Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Idioma: En Ano de publicação: 2023 Tipo de documento: Article