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J Reconstr Microsurg 2022; 38(05): 371-377
DOI: 10.1055/s-0041-1733993
Original Article

Utility of ERAS Pathway in Nonabdominal-Based Microsurgical Breast Reconstruction: Efficacy in PAP Flap Reconstruction?

Min-Jeong Cho 
1   Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
,
Ricardo Garza
2   Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
,
Sumeet S. Teotia
2   Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
,
Nicholas T. Haddock
2   Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
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Abstract

Background Enhanced recovery after surgery (ERAS) protocols are effective in decreasing hospital length of stay and inpatient opioid consumption. Implementation of these protocols in abdominally based breast reconstruction has been successful. When a patient is a poor candidate for abdominally based flaps a popular secondary option is the profunda artery perforator (PAP) flap. We present our experience with implementation of our ERAS protocol in patients treated with PAP flaps for breast reconstruction.

Methods Retrospective review of patients treated with autologous breast reconstruction using PAP flaps before and after ERAS implementation were performed. Patient characteristics, postoperative oral morphine equivalents (OMEs), and flap data were collected.

Results A total of 87 patients were included in this study (58 patients in pre-ERAS and 29 patients in ERAS group). There was no statistical difference in patient age, comorbidities, smoking, and radiation between two groups. The ERAS group had statistically lower hospital length of stay (2.6 vs. 3.8 days), procedure time (315 vs. 433 minutes), postoperative day 0 (54.8 vs. 96.3), postoperative day 1 (29.9 vs. 57.7), and total opioid consumption (103.7 vs. 192.1). There was no statistical difference in average pain scores between two groups. Multivariate analysis revealed that procedure time significantly increased the amount of opioid consumption while ERAS implementation significantly reduced LOS and opioid consumption.

Conclusion Use of an ERAS protocol in PAP flap breast reconstruction has not been previously studied. Our work shows that ERAS implementation in PAP flap breast reconstruction significantly reduces inpatient opioid use and length of hospital stay.

Keywords

ERAS - breast reconstruction - profunda artery perforator - opioid usage - length of hospital stay - DIEP

Institutional Review Board Statement

IRB has approved this study.


Author's Contribution

M.-J.C. conceptualized the study, acquired data, performed the analyses, drafted the initial manuscript, reviewed and revised the manuscript, and approved the final manuscript as submitted. N.T.H. and S.S.T. conceptualized the study, critically reviewed and revised the manuscript, and approved the final manuscript as submitted.




Publication History

Received: 13 December 2020

Accepted: 22 June 2021

Article published online:
28 August 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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