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
