An Enhanced Recovery after Surgery Pathway for Microvascular Breast Reconstruction Is Safe and Effective

Astanehe, Arezoo; Temple‐Oberle, Claire; Nielsen, Markus; Haas, William de; Lindsay, Robert; Matthews, Jennifer; McKenzie, D. C.; Yeung, Justin K.; Schrag, Christiaan

doi:10.1097/gox.0000000000001634

Cited by 77 publications

(132 citation statements)

References 39 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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“…Seven studies investigated the utilization of enhanced recovery after surgery (ERAS) pathways in providing pain control after autologous breast reconstruction. 31, [33][34][35][36][37][38][39][40] Pathways varied markedly in regard to pre, intra, and postoperative interventions. All studies demonstrated a reduction in opioid utilization with ERAS approaches.…”

Section: Enhanced Recovery Pathwaysmentioning

confidence: 99%

Optimizing Postoperative Pain Control in Autologous Breast Reconstruction: A Systematic Review

Knackstedt

Oliver

Gatherwright

2020

J Reconstr Microsurg

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Background Pain management approaches in autologous breast reconstruction have become a topic of great interest in the era of enhanced recovery after surgery protocols, as well as the opioid epidemic. The management of postoperative pain is of critical importance for women undergoing breast reconstruction; however, these protocols have yet to be synthesized and compared in the primary literature. Herein, we present a systematic review of approaches to provide optimal pain control while minimizing narcotic use and its associated potential negative sequelae in autologous breast reconstruction. Methods A comprehensive systematic review of the published literature was conducted using Ovid Medline/PubMed database without timeframe limitations, in compliance with the guidelines outlined in the Preferred Reporting Items for Systematic reviews and Meta-Analyses. Inclusion criteria were selected for studies reporting objective outcomes of pain modulation in autologous breast reconstruction. Articles for inclusion were stratified based on intervention. Results A total of 101 articles were identified on initial search query. After full-text review and final screening of all articles and review of included studies’ references, 28 studies met the inclusion criteria and were analyzed. Conclusion There continues to be a substantial need for evidence-based guidelines in the plastic surgery literature. Mitigating postoperative pain can improve health-related quality of life, reduce health care resource utilization and costs, and minimize perioperative opiate use. Given the increasing popularity of and access to autologous approaches to breast reconstruction, we hope this area of study continues to be a top priority for plastic surgeons to allow for optimized postoperative care.

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“…Using surgery specific protocols and checklists creates a standardized care plan which encourages patient engagement and creates a collaborative team structure. Recently, Astanehe et al 101 reported significantly decreased narcotic and antiemetic use, early regular diet tolerance and mobilization, and less hospital stay after developing an ERAS (early recovery after surgery) guideline based care protocol for microsurgery patients.…”

Section: Teamwork and Surgical Efficacymentioning

confidence: 99%

Patient Safety in Microvascular Plastic Surgery

Colakoğlu

Tebockhorst

Chong

et al. 2019

J reconstr Microsurg

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Patient safety is defined as freedom from accidental or preventable harm produced by medical care. The identification of patient- and procedure-related risk factors enables the surgical team to carry out prophylactic measures to reduce the rate of complications and adverse events.The purpose of this review is to identify the characteristics of patients, practitioners, and microvascular surgical procedures that place patients at risk for preventable harm, and to discuss evidence-based prevention practices that can potentially help to generate a culture of patient safety.

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An Enhanced Recovery after Surgery Pathway for Microvascular Breast Reconstruction Is Safe and Effective

Abstract: Supplemental Digital Content is available in the text.

Cited by 77 publications

References 39 publications

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

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

Optimizing Postoperative Pain Control in Autologous Breast Reconstruction: A Systematic Review

Patient Safety in Microvascular Plastic Surgery

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