Introducing the fast track surgery principles can reduce length of stay after autologous breast reconstruction using free flaps: A case control study

Abstract

By introducing a simple, peri- and postoperative care concept it is possible to reduce LOS after microsurgery by at least 1 day without an increase in complications or flap loss.

ERAS—Value based surgery

“…Multiple meta‐analyses from colorectal and non‐colorectal abdominal surgeries all show faster recovery and in many operations also reduced complications. The same trend is true for many non‐abdominal surgeries, such as hip and knee replacement in the elderly, and plastic surgery . Large cohorts also indicate that introduction of ERAS programs may reduce the risks commonly associated with comorbidities such as diabetes .…”

Is Enhanced Recovery the New Standard of Care in Microsurgical Breast Reconstruction?

“…However, to date, only a few ERPs have been described in the plastic surgery literature (3–5, 21, 22). Batdorf et al initially described a comprehensive ERP for microsurgical breast reconstruction (3).…”

“…They identified the use of multimodal analgesia, lower American Society of Anesthesiologists class, and surgery >6 months after implementation of the pathway as predictors of shorter time to discharge. Bonde et al (5) reported outcomes among patients undergoing unilateral breast reconstruction and found a decrease in mean LOS, from 7.4 to 6.2 days. They continued to improve on their fast-track protocol with the identification of specific factors that prolonged hospital stay.…”

“…However, opioid-related adverse drug events, such as nausea and constipation, continue to be a problem in the postoperative setting for patients with breast cancer (1, 2). Recently, there has been an increased focus on using enhanced recovery pathways (ERPs) in reconstructive breast surgery to further improve outcomes, such as early mobilization, optimization of pain control, and earlier hospital discharge (3–5). These ERPs aim to achieve early postoperative recovery by maintaining preoperative organ function and reducing surgical stress during and after surgery.…”

“…Only a few reports of ERPs being used in microsurgical breast reconstruction are available (3–5, 8). These studies have typically focused on a homogeneous patient population or were limited to 1 or 2 microsurgeons.…”