Enhanced Recovery After Surgery: The Plastic Surgery Paradigm Shift

Bartlett, Erica L.; Zavlin, Dmitry; Friedman, Jeffrey D.; Abdollahi, Aariane; Rappaport, Norman H.

doi:10.1093/asj/sjx217

Cited by 43 publications

(27 citation statements)

References 30 publications

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“…Recent developments in expedited recovery after surgery protocols support this idea, as it is now becoming commonplace to offer narcotic-limiting pain control regimens that do not require inpatient intravenous administration. 28,29 As recently reported in the literature, these factors have already been paired with advanced surgical techniques, such as ribsparing exposure of the mammary vessels and microrectusfascial incisions for flap harvest, to further limit pain and expedite recovery to successfully perform microsurgical breast reconstructions in the ambulatory setting. 30 However, larger prospective studies are still needed to verify these results before these techniques are broadly adopted.…”

Section: Discussionmentioning

confidence: 98%

Inpatient Flap Monitoring after Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction: How Long Is Long Enough?

Carruthers

Tiwari²,

Yoshida³

et al. 2019

J reconstr Microsurg

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Background There is a growing trend across health care to perform increasingly complex procedures in less acute settings. This shift has been fueled, in part, by enhanced recovery protocols, which have shortened hospital stays after major surgeries. We set out to determine the timing of microvascular complications after deep inferior epigastric artery perforator (DIEP) free flap breast reconstruction in a high-volume practice using continuous flap monitoring technologies. Methods The medical charts of all patients who underwent breast reconstruction with DIEP flaps over 24 consecutive months were reviewed. Postoperatively, all flaps were monitored according to a protocol that included continuous tissue oximetry with near-infrared spectroscopy. The primary end points evaluated included any unplanned return to the operating room, time to takeback, and flap loss rate. Results A total of 196 patients underwent breast reconstruction with a total of 301 DIEP flaps. Five of the flaps (1.7%) were taken back to the operating room for microvascular issues, and nine (3.0%) were taken back for nonvascular issues. Of patients who were brought back for microvascular issues, all five (100.0%) were initially identified by continuous noninvasive monitoring and taken back to the operating room within the first 14 hours (range: 1.2–13.6 hours). In the series, the flap failure rate was 0.66% (n = 2). Conclusion All of the microvascular issues were detected in the initial 23 hours after surgery, leading to prompt flap salvage. The results of this study bring into question the need for lengthy flap monitoring protocols and suggest that shorter inpatient, or even observation admissions, may be reasonable, particularly when flap monitoring protocols incorporating continuous noninvasive flap monitoring are used.

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Section: Discussionmentioning

confidence: 98%

Inpatient Flap Monitoring after Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction: How Long Is Long Enough?

Carruthers

Tiwari²,

Yoshida³

et al. 2019

J reconstr Microsurg

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“…In order to properly apply the recommendations, a patient undergoing body contouring surgery must be selected according to specific parameters [4] and preferably without comorbidities. Increased metabolic stress and insulin resistance are closely associated with fasting long periods [10], which may result in nausea, vomiting, and increased morbidity and mortality, including prolonged hospital stay and longer recovery period [1]; there are several perioperative guidelines and protocols published in order to avoid them [5,6,8]. In the case of body contouring surgeries, they are particularly useful and can be divided into:…”

Section: Preoperative Managementmentioning

confidence: 99%

“…These symptoms are a common cause of longer hospitalizations [11,23,24]. Among the recommendations for postoperative analgesia, treatment with ketorolac and then with paracetamol, nonsteroidal anti-inflammatory drugs, and gabapentin are recommended [25,26].…”

Section: Prevention and Treatment Of Painmentioning

confidence: 99%

“…As preoperative planning, celecoxib (200-400 mg), gabapentin (300-600 mg), and ondansetron (8 mg) are started as premedication one night before surgery and the surgery morning. Intraoperatively, dexamethasone (8 mg) and promethazine (25 mg) are added after induction, either intravenously or in suppository [26], in addition to fentanyl and propofol per kilogram of weight [23]. In breast surgery, the protocols also include regional anesthesia by paravertebral blocks [25] and in abdominoplasty the use of liposomal bupivacaine [27] (0.25-0.5%) below the rectus abdominis sheath [25] or transverse abdominal plane block.…”

Section: Prevention and Treatment Of Painmentioning

confidence: 99%

“…The accelerated recovery protocol after surgery originated in the 1990s after findings from major research groups in elective surgery [29] demonstrated improved hydration, reduced incidence of bleeding, transfusions, and complications of thrombosis [1].…”

Section: Hemodynamicsmentioning

confidence: 99%

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Fast Recovery in Esthetic Body Contouring Surgery

Durán¹,

Camarena²,

Bayter³

et al. 2020

Surgical Recovery

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Body contouring surgery is worldwide accepted as one of the most successful esthetic surgeries. Lipectomy, liposuction, and buttock fat infiltration are among the most frequent procedures realized, but also, they are not free of complications as any other surgery. A strategy to overcome these complications is to provide the patient with a good perioperative care, to improve every aspect of recovery. The areas to be improved are nutrition, immunology, pain and inflammation, hemodynamics, early mobilization, patient education and communication, and leadership to evaluate if it is correctly been done. The implementation of these fast recovery strategies is the best approach for our patients, with cost-efficiency optimization, a better experience, and a high overall satisfaction during the whole process. It constitutes a paradigm shift from the traditional steps around the well-being of the patient. If all the areas are covered and improved, the patient should have a fast recovery and a good experience of the surgery.

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