Examining Length of Hospital Stay after Microsurgical Breast Reconstruction: Evaluation in a Case-Control Study

Abstract

Background:While possessing numerous benefits, microsurgical breast reconstruction is associated with longer operative times and post-operative hospital length of stay compared to implant-based reconstruction. We therefore evaluate factors associated with increased length of stay (LOS) after microsurgical breast reconstruction with a case-control study design.Methods:All patients undergoing immediate or delayed abdominally-based microsurgical breast reconstruction over a two-year time period were identified. Risk factors associated with LOS greater than or equal to 5 days were identified.Results:A total of 116 patients undergoing immediate or delayed abdominally-based microsurgical breast reconstruction were identified. Of these, 86 (74.1%) had a LOS of 4 days or less (mean: 3.70 days) while 30 (25.9%) had a LOS of 5 days or greater (mean: 5.50 days).With regards to patient demographics and intra-operative factors, patients with a LOS of 5 days or greater were significantly more likely to have diabetes mellitus (p < 0.0001), undergo bilateral reconstruction (p = 0.0003) and total mastectomy (p < 0.0001), and have a longer operative time (p < 0.0001) while significantly less likely to undergo post-operative radiation (p = 0.0421). Notably, there was no significant difference between the groups in terms of follow-up time, or time since breast reconstruction (p = 0.0600).With regards to reconstructive complications, patients with LOS of 5 days of greater were significantly more likely to experience abdominal donor site abscess (p < 0.0001), breast hematoma (p = 0.0186), and return to the operating room for flap compromise (p < 0.0001).Conclusions:Multiple patient-specific, intra-operative, and post-operative outcomes factors are associated with increased length of stay with immediate and delayed microsurgical breast reconstruction.

Does surgical procedure type impact postoperative pain and recovery in deep inferior epigastric artery perforator flap breast reconstruction?

“…Bilateral reconstructions had statistically and clinically significantly longer lengths of stay by 2.4 days ( Table 2). This increase for bilateral procedures is well documented in the literature [15]. It is also expected as bilateral surgery is more invasive, lasts longer and is associated with a longer recovery in terms of mobilization.…”

“…Our length of stay is however similar to representative UK cohorts of DIEP and other autologous tissue-based breast reconstructions which have reported mean length of stay ranging between 6.8 and 10.2 days [ 16 - 18 ]. Historically earlier discharges have been reported in North American studies with mean length of stay between 4 and 5 days [ 14 , 15 , 19 , 20 ].…”

Use of Closed Incision Negative Pressure Therapy (ciNPT) in Breast Reconstruction Abdominal Free Flap Donor Sites

“…Patients who received ciNPT were required to remain an inpatient for at least 5–7 days for nursing care until the Prevena dressing was removed, precluding this measure from being clinically relevant when measuring wound complication outcomes. Patients with comorbidities such as diabetes may require increased length of stay to optimize glycaemic management pre- and post-surgery [ 19 , 20 , 21 ]. In addition, obesity has been linked to an increased length of stay with longer observation periods often due to a prolonged, more complex postoperative recovery [ 18 , 21 , 22 , 23 , 24 ].…”

“…Patients with comorbidities such as diabetes may require increased length of stay to optimize glycaemic management pre- and post-surgery [ 19 , 20 , 21 ]. In addition, obesity has been linked to an increased length of stay with longer observation periods often due to a prolonged, more complex postoperative recovery [ 18 , 21 , 22 , 23 , 24 ].…”

Do Patient Expectations of Discharge Affect Length of Stay after Deep Inferior Epigastric Perforator Flap for Breast Reconstruction?

“…[12][13][14][15][16][17] The literature also shows that transversus abdominis plane (TAP) blocks reduce the level of narcotics that patients require to control their pain after abdominally based breast reconstruction. 18,19 Goals of DIEP flap postoperative protocols include enhanced patient outcomes, improved pain control with minimizing narcotics, and controlling costs with decreasing LOS. Previous investigators in other fields have shown that patient expectations of hospital stay after surgery may affect inpatient stay after surgery.…”