Abstract
Background Enhanced Recovery After Surgery (ERAS) protocols have decreased postoperative opioid
consumption and hospital length of stay in deep inferior epigastric perforator (DIEP)
flap breast reconstruction. We aim to evaluate whether there needs to be further adjustments
to best improve outcomes specifically in patients with a preexisting psychiatric condition.
Methods A retrospective review was performed of all patients that underwent DIEP flap breast
reconstruction between October 2018 and September 2020. This includes all patients
with the most recent ERAS protocol implementation of intraoperative transverse abdominal
plane blocks with liposomal bupivacaine. We looked at patients with a psychiatric
diagnosis at the time of surgery. Specifically, forms of depression and anxiety were
the psychiatric diagnoses for these patients. We divided these patients into three
groups: those with no diagnoses, those with a single diagnosis, and those with both
diagnoses. Primary outcomes observed were postoperative opioid consumption and length
of stay. A one-way analysis of variance determined whether there was a difference
between the three groups and a Tukey post hoc analysis made pairwise comparisons.
A p-value of < 0.05 was significant.
Results A total of 176 patients were analyzed in this study: 59 (33.5%) of our study population
had a diagnosis of either depression, anxiety, or both. Postoperative opioid consumption
was higher in patients with a psychiatric diagnosis compared with those without (123.8
to 91.5; p < 0.0005). A multiple regression model consisting of operating time, hospital length
of stay, whether the patient has a psychiatric diagnosis, and history of chemotherapy
statistically significantly predicted opioid consumption (p < 0.0005).
Conclusion With similar hospital length of stay postoperatively, it is notable that patients
with a psychiatric diagnosis had significantly higher amounts of postoperative opioid
consumption. This study highlights the need to further improve multidisciplinary integrated
care for patients with psychiatric comorbidities to improve pain management postoperatively.
Keywords
DIEP - depression and anxiety - opioid
