Enhanced Recovery after Surgery Pathway for Microsurgical Breast Reconstruction: A Systematic Review and Meta-Analysis

Abstract

Background: The enhanced recovery after surgery pathway was introduced in 1997 as a multimodal approach to reduce preventable postoperative harm and shorten hospital length of stay. However, there is yet no widely accepted enhanced recovery after surgery protocol for microsurgical breast reconstruction. The authors conducted a systematic review and meta-analysis of the current literature on enhanced recovery after surgery for microsurgical breast reconstruction with regard to postoperative length of stay and morbidity. Methods: The PubMed, Embase, Cochrane, Scopus, and Web of Science databases were searched for all studies published before June of 2016 containing original data on enhanced recovery after surgery in microsurgical breast reconstruction in relation to postoperative length of stay and morbidity. Studies were screened using eligibility criteria. Meta-analysis, odds ratio, and 95 percent confidence interval were used to pool acquired data. Results: The initial search identified 86 studies. Two independent screeners identified four original articles with a total of 676 patients. Length of stay was significantly shorter for patients on an enhanced recovery after surgery pathway (mean difference, −1.23; 95 percent CI, −1.50 to −0.96; p < 0.001; I 2 = 0 percent; random effects model). Enhanced recovery was not associated with changes in 30-day postoperative morbidity; specifically, no significant difference was observed in rates of partial flap loss (p = 0.44), total flap loss (p = 0.91), breast hematoma (p = 0.69), donor-site infection (p = 0.53), urinary tract infection (p = 0.29), and pneumonia (p = 0.42). Conclusion: The authors’ review suggests that enhanced recovery after surgery in microsurgical breast reconstruction is associated with a reduced length of stay, and is not associated with increased postoperative morbidity.

Fast-Track Approach for Breast Reconstructive Surgery in Patients With Breast Cancer

“…Key recommendations support early mobilization after surgery, early feeding, adequate warming up patients during and after surgery, and using minimum drugs to control pain and nausea after surgery. [8][9][10] Comparing the data obtained from our research with the world literary data, we noted that FTS is a program that exists for a short time and practically was not used in BC surgery. Therefore, there are only separate messages on the specified subject.…”

Enhanced recovery after surgery on multiple clinical outcomes

“…All of the 55 articles investigated the impact of ERAS/FTS on clinical outcomes compared with conventional care mode involved in colorectal surgery (n = 13), [ 3 , 31 – 42 ] liver surgery (n = 7), [ 43 – 49 ] gastric surgery (n = 7), [ 22 , 50 – 55 ] orthopedic surgery (n = 3), [ 56 – 58 ] bariatric surgery (n = 3), [ 59 – 61 ] urology surgery (n = 3), [ 62 – 64 ] breast surgery (n = 3), [ 65 – 67 ] esophageal surgery (n = 3), [ 68 – 70 ] pancreatic surgery (n = 3) [ 71 – 73 ] and other surgeries (n = 10) [ 4 , 74 – 82 ] including gynecologic surgery, [ 74 ] abdominal aortic aneurysm repair surgery, [ 76 ] lung surgery [ 77 ] and vascular operations. [ 79 ] The most clinical results were measured in the meta-analyses are length of hospital stay (LOS)/post-operative hospital stay (PLOS) (n = 47), cost (n = 16), mortality (n = 30), morbidity (n = 54), readmission (n = 42), reoperation (n = 8) and other secondary outcomes.…”

Transversus Abdominis Plane Blocks in Microsurgical Breast Reconstruction: A Systematic Review and Meta-analysis

“…Four out of five included studies in a systematic review of ERAS pathways in microsurgical breast reconstruction incorporated local anesthetics into their protocol; however, only one of them was TAP blocks. 34 Our review indicates that TAP blocks represent a safe and effective modality to achieve lower postoperative narcotic consumption and pain while facilitating earlier discharge and should be strongly considered in ERAS protocols for autologous breast reconstruction patients.…”

“…[30][31][32][33] A 2018 meta-analysis found that ERAS pathways for autologous breast reconstruction significantly reduced LoS by an average of 1.2 days without increasing 30-day complication rates. 34 These multimodal protocols consist of pre-, intra-, and postoperative components. Preoperative measures encompass imaging for improved surgical planning, optimizing diet, and administrating nonopioid analgesia and antiemetics.…”