Enhanced Recovery After Surgery (ERAS) Protocol Enables Safe Same-Day Discharge After Alloplastic Breast Reconstruction

Dumestre, Danielle; Redwood, Jennifer; Webb, Carmen; Temple‐Oberle, Claire

doi:10.1177/2292550317728036

Cited by 55 publications

(95 citation statements)

References 43 publications

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“…Studies were performed between 2011 and 2018 and comprised 11 cohort studies, 3 of which included a single cohort of ERAS patients, whereas 8 included a traditional pathway control cohort. [9][10][11][12][13][14][15][16][17][18][19] The traditional cohort was collected through retrospective chart review of recent patients who underwent breast reconstruction with the perioperative standard of care. 11,12,[14][15][16][17][18][19] Significant differences between cohorts in terms of patient and surgical characteristics were rare, as shown in individual tables present in each manuscript.…”

Section: Study Detailsmentioning

confidence: 99%

“…The majority of patients underwent tissue expander placement (518, 84.8%), and a minority underwent direct-to-implant reconstruction using allo-or autodermis to complete implant coverage (93, 15.2%). [17][18][19] The majority of alloplastic cases were unilateral (373, 75.8%) and immediate (609, 99.7%).…”

Section: Patient Characteristicsmentioning

confidence: 99%

“…12,13 Alloplastic Reconstruction: Protocol Details Preoperative education and counseling regarding the procedure and enhanced recovery were described in all studies. [17][18][19] The majority limited preoperative fasting, with clear liquids permitted up to 2 hours prior to anesthetic induction. 18,19 A multimodal pain control regimen was administered preoperatively in all protocols in which preoperative pain control was discussed (n ¼ 2), including acetaminophen (2/2), gabapentin (2/2), celecoxib (1/2), and an oral opioid (1/2).…”

Section: Autologous Reconstruction-protocol Detailsmentioning

confidence: 99%

“…[17][18][19] The majority limited preoperative fasting, with clear liquids permitted up to 2 hours prior to anesthetic induction. 18,19 A multimodal pain control regimen was administered preoperatively in all protocols in which preoperative pain control was discussed (n ¼ 2), including acetaminophen (2/2), gabapentin (2/2), celecoxib (1/2), and an oral opioid (1/2). Intraoperatively, pain control was most often left to the anesthesiologist's discretion.…”

Section: Autologous Reconstruction-protocol Detailsmentioning

confidence: 99%

“…Intraoperatively, pain control was most often left to the anesthesiologist's discretion. 18,19 Dumestre et al utilized local nerve blocks around the breast with bupivacaine, and Chiu et al utilized pectoralis or paravertebral blockade with ropivacaine. 18,19 Goal-directed fluid management targeting euvolemia was stressed.…”

Section: Autologous Reconstruction-protocol Detailsmentioning

confidence: 99%

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Enhanced Recovery after Surgery in Breast Reconstruction: A Systematic Review

Soteropulos

Tang

Poore

2019

J reconstr Microsurg

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Background Enhanced Recovery after Surgery (ERAS) principles have received focused attention in breast reconstruction. Many protocols have been described in the literature for both autologous and alloplastic reconstruction. This systematic review serves to better characterize successful ERAS protocols described in the literature for potential ease of adoption at institutions desiring implementation. Methods A systematic review of ERAS protocols for autologous and alloplastic breast reconstruction was conducted using Medline, the Cochrane Database, and Web of Science. Results Eleven cohort studies evaluating ERAS protocols for autologous (n = 8) and alloplastic (n = 3) breast reconstruction were included for review. The majority compared with a retrospective cohort of traditional perioperative care. All studies described the full spectrum of implemented ERAS protocols including preoperative, intraoperative, and postoperative phases of care. Most frequently reported significant outcomes were reduced length of stay and opioid use with ERAS implementation. No significant change in major complication or readmission rate was demonstrated. Conclusion Based on this systematic review, several core elements that make up a successful perioperative enhanced recovery protocol for breast reconstruction have been identified. Elements include patient counseling and education, limited preoperative fasting, appropriate thromboprophylaxis and antibiotic prophylaxis dependent on reconstructive method, preoperative antiemetics, multimodal analgesia and use of local anesthetic, goal-directed intravenous fluid management, prompt removal of drains and catheters, early diet advancement, and encouragement of ambulation postoperatively. Implementation of ERAS protocols in both autologous and alloplastic breast reconstruction can positively enhance patient experience and improve outcomes by reducing length of stay and opioid use, without compromising successful reconstructive outcomes.

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Section: Study Detailsmentioning

confidence: 99%

Section: Patient Characteristicsmentioning

confidence: 99%

Section: Autologous Reconstruction-protocol Detailsmentioning

confidence: 99%

Section: Autologous Reconstruction-protocol Detailsmentioning

confidence: 99%

Section: Autologous Reconstruction-protocol Detailsmentioning

confidence: 99%

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Enhanced Recovery after Surgery in Breast Reconstruction: A Systematic Review

Soteropulos

Tang

Poore

2019

J reconstr Microsurg

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Effect of Smartphone App Postoperative Home Monitoring After Oncologic Surgery on Quality of Recovery

et al. 2023

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ImportanceThere has been an increase in health care–focused smartphone apps, including those for encouraging healthy behaviors and managing chronic conditions, but app-assisted postsurgical care has yet to be fully explored.ObjectiveTo compare quality of recovery and patient satisfaction between conventional in-person follow-up and smartphone app–assisted follow-up for patients following Enhanced Recovery After Surgery Society (ERAS) protocols.Design, Setting, and ParticipantsThis randomized clinical trial, conducted from June 2019 to April 2021, included women older than 18 years undergoing oncologic breast reconstruction or major gynecologic oncology surgery following ERAS protocols with the care of 2 surgeons at an academic tertiary care center.InterventionsPatients were randomized 1:1 to receive smartphone app–assisted follow-up or conventional in-person follow-up. The smartphone group used a surgeon-monitored app to record Quality of Recovery 15 (QoR15) scores, European Organisation for Research and Treatment of Cancer–selected adverse events, drain outputs, and surgical site photographs over 6 weeks. Patient satisfaction scores were assessed using validated Patient Satisfaction Questionnaire III (PSQ-III) subscales at 2 and 6 weeks postoperatively. The conventional follow-up group also completed the QoR15 and PSQ-III questionnaires at these intervals.Main Outcomes and MeasuresThe primary outcomes were quality of recovery and patient satisfaction, as measured by the QoR15 and PSQ-III, respectively. Secondary outcomes were costs of follow-up; the number of contacts with the medical system, complications, and surgeons’ contacts with patients; and surgeons’ perceptions of app-assisted care.ResultsOf 72 patients included in the trial, 36 underwent breast reconstruction (mean [SD] age, 45.30 [9.13] years) and 36 underwent gynecologic oncology surgery (mean [SD] age, 54.90 [11.18] years). Three patients dropped out (2 who underwent breast reconstruction [1 in the app group, 1 in the control group], 1 who underwent gynecologic oncology surgery [control group]). The app group had significantly higher mean (SD) QoR15 scores than the control group (2 weeks: 127.58 [22.03] vs 117.68 [17.52], P = .02; 6 weeks: 136.64 [17.53] vs 129.76 [16.42], P = .03). Patients were equally satisfied between groups in all subsets of the PSQ-III at these intervals. The mean (SD) number of complications was similar in both groups, and a similar number of surgeon contacts per patient occurred (1.6 [1.2] vs 2.1 [2.0], P = .16). Surgeons appreciated early identification of complications with the app.Conclusions and RelevanceIn this randomized clinical trial, postoperative follow-up for patients undergoing breast reconstruction and gynecologic oncology surgery using smartphone app–assisted monitoring led to improved quality of recovery and equal satisfaction with care compared with conventional in-person follow-up.Trial RegistrationClinicalTrials.gov Identifier: NCT03456167

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Interventions for reducing the use of opioids in breast reconstruction

Siotos

Cheah

Karahalios

et al. 2020

Cochrane Database of Systematic Reviews

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Data extraction and managementTwo review authors (CS, MAC) will develop a standard data extraction form and independently extract data from the included studies. A third review author (GDR) will resolve any disagreements regarding data collection and extraction. We will collect information on study design, participants, setting, interventions, outcomes, follow-up, methods employed to control for confounders and biases, sources of funding, and notable conflicts of interest of trial authors, amongst other items. For observational studies where we extract adjusted estimates, we will select the most fully adjusted model. Should we identify multiple papers that report results from the same study during the data extraction process, we will select a single paper as the primary Interventions for reducing the use of opioids in breast reconstruction (Protocol)

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Enhanced Recovery After Surgery (ERAS) Protocol Enables Safe Same-Day Discharge After Alloplastic Breast Reconstruction

Abstract: The ERAS protocol for alloplastic breast reconstruction is safe, without increased readmission or complication rates compared to TRAS, and significantly decreased length of stay.

Cited by 55 publications

References 43 publications

Enhanced Recovery after Surgery in Breast Reconstruction: A Systematic Review

Enhanced Recovery after Surgery in Breast Reconstruction: A Systematic Review

Effect of Smartphone App Postoperative Home Monitoring After Oncologic Surgery on Quality of Recovery

Interventions for reducing the use of opioids in breast reconstruction

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