Improved Recovery Experience Achieved for Women Undergoing Implant-Based Breast Reconstruction Using an Enhanced Recovery after Surgery Model

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

doi:10.1097/prs.0000000000003056

Cited by 85 publications

(96 citation statements)

References 44 publications

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“…Since these patients have longer and more invasive surgeries, they are at higher risk for postoperative nausea and vomiting as well as inadequate analgesia and would likely benefit from an enhanced recovery pathway for general postoperative care. An enhanced recovery after surgery protocol for patients undergoing mastectomy with implant‐based reconstruction can make same day discharge possible with improved patient satisfaction and no increase in complications …”

Section: Discussionmentioning

confidence: 99%

“…An enhanced recovery after surgery protocol for patients undergoing mastectomy with implant-based reconstruction can make same day discharge possible with improved patient satisfaction and no increase in complications. 16 Preoperative paravertebral block (PVB) reduces postoperative pain. 17,18 Patients in our study undergoing bilateral procedures were more likely to undergo preoperative PVB, possibly explaining the association on univariate analysis and lack thereof on multivariate analysis.…”

Section: Discussionmentioning

confidence: 99%

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Variables associated with length of stay in patients undergoing mastectomy and delayed‐immediate breast reconstruction with tissue expander

et al. 2019

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Delayed‐immediate reconstruction with the placement of tissue expanders at the time of mastectomy is a common approach to breast reconstruction. The purpose of this study was to identify variables associated with increased LOS in patients that underwent bilateral or unilateral mastectomy with tissue expander placement. Bilateral procedure, a diagnosis of anxiety or depression, and age >55 years were independently associated with increased LOS. More recent year of surgery and Friday surgery were associated with decreased LOS.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Variables associated with length of stay in patients undergoing mastectomy and delayed‐immediate breast reconstruction with tissue expander

et al. 2019

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“…Implementation of ERAS protocols have been associated with a decrease in length of hospital stay, improved pain control, expeditious postoperative recovery, and decreased morbidity in a variety of surgical specialties, including colorectal, vascular, hepatobiliary, orthopedic, and gynecologic surgery . Beneficial effects of ERAS protocols following plastic surgery procedures have been observed as well . The combination of superior postoperative outcomes and decreased length of stay, and thus, decreased health care cost, is particularly appealing and has resulted in implementation of ERAS protocols as an increasingly common quality improvement initiative at various medical centers …”

Section: Introductionmentioning

confidence: 99%

“…[11][12][13][14][15][16][17] Beneficial effects of ERAS protocols following plastic surgery procedures have been observed as well. 18,19 The combination of superior postoperative outcomes and decreased length of stay, and thus, decreased health care cost, is particularly appealing and has resulted in implementation of ERAS protocols as an increasingly common quality improvement initiative at various medical centers. 19,20 The importance of adequate postoperative pain control is reflected in the observation that the immediate effects of inadequate control of acute postoperative pain results in prolonged hospitalization with the long-term risk being the development of chronic pain.…”

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confidence: 99%

Postoperative analgesia after microsurgical breast reconstruction using liposomal bupivacaine (Exparel)

et al. 2019

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Conventional opioid‐based regimen for postoperative analgesia after autologous breast reconstruction can be associated with significant side effects. The purpose of this study was to assess the efficacy of an intraoperatively administered transversus abdominis plane (TAP) block with liposomal bupivacaine on postoperative narcotic use in patients undergoing microsurgical breast reconstruction with free abdominal flaps. Patients treated between December 2016 and June 2017 were included in the study. Parameters of interest were patient‐reported pain score, total narcotic use (in oral morphine equivalent [OME]) during the hospitalization, length of stay (LOS), and the need for patient‐controlled analgesia (PCA). Eighty‐two free abdominal flaps were transferred in 46 patients with a mean age of 47.6 years and a mean body mass index (BMI) of 28.1 kg/m2. The average LOS was 3.5 days (range, 3‐5). Postoperatively, 42 patients (91.3%) did not require patient‐controlled analgesia (PCA). The mean time to first narcotic use after arrival on the nursing unit was 6 hours (range, 0‐19 hours). The mean total postoperative OME use was 123.2 mg (range, 0‐285 mg). However, analysis of OME use excluding the four patients requiring PCA revealed a mean OME use of 90.3 mg (range, 0‐167.5 mg). Liposomal bupivacaine provides for reliable, safe, and long‐acting postoperative analgesia and contributes to a reduction in postoperative narcotic intake. The use of liposomal bupivacaine shows great promise in improving the standard of care in postoperative analgesia in microsurgical breast reconstruction.

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“…Στην Ελλάδα δεν έχει εκδοθεί από κάποιο επίσηµο κρατικό φορέα πρωτόκολλο ERAS για την άµεση αποκατάσταση µε διατατήρες µετά από µαστεκτοµή. Παράλληλα, σε αρκετά ιδιωτικά νοσοκοµεία εφαρµόζονται παρόµοια προγράµµατα για την αποκατάσταση µετά από µαστεκτοµή µε µεγάλη µείωση της συνολικής µέσης διάρκειας νοσηλείας από 3,6 ηµέρες πριν από την εφαρµογή του προγράµµατος ERAS σε 0 (αυθηµερόν εξιτήριο) έως 1,2 ηµέρες (Mertz et al 2013, Dumestre et al 2017, Afonso et al 2017.…”

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Enhanced Recovery after Surgery (ERAS) protocols in breast cancer patients undergoing post-mastectomy breast reconstruction with tissue expander

Bourazani

Kelesi²,

Fasoi³

2019

HJNS

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A lot of women choose the immediate breast reconstruction after mastectomy. The most common method is breast reconstruction using tissue expanders. Women's way of life and the economic crisis have created the need for adopting enhanced recovery after surgery (ERAS) protocols and early hospital discharge. The present study aims at informing perioperative nurses about the ERAS protocols and encouraging their implementation. ERAS protocols in breast cancer patients undergoing immediate post-mastectomy breast reconstruction include a combination of evidence-based interoperative interventions with the participation of surgeons, anesthetists, nurses, physiotherapists, and dietitians as members of the multidisciplinary team. This is a multifactorial approach to postoperative rehabilitation and care of the surgical patient. ERAS protocols are easy to apply, reduce morbidity, perioperative anxiety, postoperative pain, postoperative complications and hospitalization. In addition, they reduce the cost of treatment and hospitalization. The patient's approach to breast cancer following an ERAS protocol is divided into three phases: pre-surgical, intraoperative and post-operative. It starts before the patient’s hospitalization and continues until they are discharged, requiring active participation throughout the process. The total average hospitalization for post-mastectomy rehabilitation decreased from 3.6 days, prior to ERAS implementation, to 0 (discharging the same day) to 1.2 days post-surgery, releasing 30% of the beds. In conclusion, the ERAS protocols, following evidence-based perioperative care, promote the rapid recovery of patients aiming at reducing post-operative stress and its effects.

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Improved Recovery Experience Achieved for Women Undergoing Implant-Based Breast Reconstruction Using an Enhanced Recovery after Surgery Model

Abstract: Therapeutic, III.

Cited by 85 publications

References 44 publications

Variables associated with length of stay in patients undergoing mastectomy and delayed‐immediate breast reconstruction with tissue expander

Variables associated with length of stay in patients undergoing mastectomy and delayed‐immediate breast reconstruction with tissue expander

Postoperative analgesia after microsurgical breast reconstruction using liposomal bupivacaine (Exparel)

Enhanced Recovery after Surgery (ERAS) protocols in breast cancer patients undergoing post-mastectomy breast reconstruction with tissue expander

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