How Does Enhanced Recovery Pathway Impact the Outcomes of Microsurgical Breast Reconstruction
Malke Asaad1, Rene Largo1, Jacquelynn Tran2, Gabriel Mena1, Carrie Chu1, Mark Schaverien1, Alexander Mericli1, Anaeze Offodile1, Jesse C. Selber1.
1MD Anderson Cancer Center, Houston, TX, USA, 2University of Texas Medical Branch, Galveston, TX, USA.
Background: Enhanced recovery after surgery (ERAS) pathway is a multimodal, opioid-sparing approach to perioperative care that has recently gained momentum in autologous breast reconstruction. The purpose of this study is to assess the impact of ERAS pathway on opioid use and patient outcomes following microsurgical breast reconstruction (MSBR) at a high-volume center. Methods: A retrospective cohort study was performed on patients who underwent MSBR between June 2018-December 2018 for the conventional cohort (CC), and August 2019-December 2019 for the ERAS cohort (ERAS). Primary outcome measures included morphine milligram equivalents (MME), and 30-day complication rates. Secondary outcomes included length of hospital stay (LOS), and pain scores. Results: 186 patients were included, of whom 78 patients received ERAS pathway while the remaining 108 patients were in the CC. Similar age (p=0.64) and BMI (p=0.75) were identified in both groups. The ERAS cohort had a significantly shorter LOS (4.6 vs. 4.9 days, p=0.01), and lower overall complication rate (19% vs 33%, p=0.03). Total MME consumption was significantly lower in the ERAS cohort (18.3 vs 32.4 mg, p=0.001). Despite less opioid use, average pain scores did not significantly differ between ERAS and CC patients at any time point (2.4 vs 2.3, p=0.24). Conclusion: The implementation of ERAS pathway for MSBR improves patient outcomes by reducing length of stay, total opioid consumption and incidence of postoperative complications.
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