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

Abstract

Aim: The aim of this study was to develop and implement the concept of fast-track surgery (FTS) for reconstructive breast surgery in patients with breast cancer (BC) to improve early and long-term results of treatment. Materials and methods: The study includes 749 patients with stage 1 to 3 BC. A total of 253 patients with BC got treatment according to FTS program and were included to the core group. Other 496 patients with BC (control group) were not included to the FTS program. Patients were treated from December 2010 to December 2014. All age groups were covered (18-70 years old). Results: There was a significant difference in the average length of hospital stay (LOS) which was 14.27 ± 7.00 days in the core group and 20.11 ± 7.70 days in the control group ( P < .001). In advanced BC cases in the core group, LOS was >8 days lower comparing with the control group on average. The LOS in patients who underwent adjuvant chemotherapy was 2.7 times lower in the FTS group comparing with the control group. Conclusions: The study results allow us to recommend the concept of FTS for implementation in broad medical practice for breast reconstructive surgery in patients with BC. The FTS program was shown to be effective in all types of breast surgery, including immediate oncoplastic and reconstructive surgeries. The gradual reduction of LOS increased the number of surgeries in our department by 75% from 2008 till 2018.

Optimizing Unilateral Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Quality Improvement Study

“…Historically, after new quality improvement interventions, patients undergoing DIEP flap reconstruction were monitored as inpatients for 3–7 days to ensure timely return to the OR in the event of a vascular complication. 5,10 Here, we were able to reduce total LOS to 2 days without experiencing any additional adverse complications that might be secondary to the streamlined hospitalization experience.…”

“…After deep inferior epigastric perforator flap (DIEP) breast reconstruction, enhanced recovery after surgery (ERAS) interventions have been shown to significantly improve the management of postoperative pain. [1][2][3][4][5][6][7] Enhanced recovery after surgery standardized protocols are important because they decrease length of stay (LOS), thus reducing hospital costs and increasing patient access to complex procedures, including DIEP breast reconstruction. 3,8,9 However, despite ERAS efforts to optimize care, there is still no consensus on the length of time that is required to monitor patients after microsurgical breast reconstruction.…”

“…Historically, these patients were monitored as inpatients for 3-7 days to ensure timely return to the operating room (OR) in the event of a vascular complication. 5,10 This timing was based on the observation that nearly all microsurgical thromboses occurred within 5 days of surgery. However, more recent unpublished data from our institution have shown that 95% of complications necessitating a return to the OR after unilateral DIEP flap breast reconstruction occur within 24 hours of surgery.…”