Enhanced Recovery After Surgery for Breast Reconstruction: Pooled Meta-Analysis of 10 Observational Studies Involving 1,838 Patients

Abstract

Purpose: This study aims to explore the effectiveness and safety of the enhanced recovery after surgery (ERAS) protocol vs. traditional perioperative care programs for breast reconstruction. Methods: Three electronic databases (PubMed, EMBASE, and Cochrane Library) were searched for observational studies comparing an ERAS program with a traditional perioperative care program from database inception to 5 May 2018. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and evaluated study quality using the Newcastle-Ottawa Scale. Subgroup and sensitivity analyses were performed. The outcomes included the length of hospital stay (LOS), complication rates, pain control, costs, emergency department visits, hospital readmission, and unplanned reoperation. Results: Ten studies were included in the meta-analysis. Compared with a conventional program, ERAS was associated with significantly decreased LOS, morphine administration (including postoperative patient-controlled analgesia usage rate and duration; intravenous morphine administration on postoperative day [POD] 0, 1, 2, and 4; total intravenous morphine administration on POD 0–3; oral morphine consumption on POD 0–4; and total postoperative oral morphine consumption), and pain scores (postoperative pain score on POD 0 and total pain score on POD 0–3). The other variables did not differ significantly. Conclusion: Our results suggest that ERAS protocols can decrease LOS and morphine equivalent dosing; therefore, further larger, and better-quality studies that report on bleeding amount and patient satisfaction are needed to validate our findings.

Setting up a new microsurgical breast service in a non-tertiary hospital: Is it safe, and do outcomes compare to centres of excellence?

“…They reported an increase in abdominal complications in their enhanced recovery protocol group due to early mobilisation -36% vs 51% 27 . This similar to the findings of a recent systematic review 8 . In contrast, we had very low rate of abdominal wound infection (2/28) and no incidence of delayed wound healing at the donor site.…”

“…A key aim of enhanced recovery protocols (ERAS) is reducing the length of hospital stay. Recent publications of enhanced recovery protocols from well-established large volume centres have demonstrated a median length of stay between 4-7 days [4][5][6][7][8][9][10][11]26 .…”

“…Many units see autologous reconstruction as a complex procedure that is best performed at a high volume centres with a long-established history of microsurgery and excellent outcomes [4][5][6][7][8][9][10][11][12] . The problem with this approach is that patients can be denied this form of reconstruction due to a geographical availability, especially when the surgery is time critical, or be required to travel significant distances, often with complete transfer of their care, to a centre that offers it 13 .…”

Enhanced Recovery After Surgery for Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: A Systematic Review and Meta-Analysis

“…Our results concur with other meta-analysis studies on the ERAS program. Tan et al ( 35 ) on breast reconstruction, Malczak et al ( 34 ) on bariatric surgery, Zhuang et al ( 13 ) on colorectal surgery; have all demonstrated that implementation of ERAS leads to significantly reduced LOS.…”

The Effect of Lavender Oil on Perioperative Pain, Anxiety, Depression, and Sleep after Microvascular Breast Reconstruction: A Prospective, Single-Blinded, Randomized, Controlled Trial

“…The use of ERAS pathways in microvascular breast reconstruction have been shown to reduce opioid use and improve pain control as compared with traditional postsurgical pathways. 35,36 It is unclear if the effects of lavender aromatherapy may be more pronounced in the absence of the perioperative multimodal pain regimens seen in conjunction with ERAS pathways.…”