Enhanced Recovery After Surgery (ERAS) Protocol Allows Safe Same-Day Discharge in Expander Based and Oncoplastic Breast Reconstruction
Ellen Niu, BS1, James Frageau, BS1, Hunter Rogoff, BS1, Brigette Cannata, BS1, Katherine E. Wang, BA, MBE1, Jocellie Marquez, MD, MBA3 Anastasia Bakoulis, DO2, Patricia Farrelly, MD2, Brian O'Hea, MD2, Tara L. Huston, MD, FACS3
1Stony Brook University School of Medicine, Stony Brook, New York, USA2Division of Breast Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, New York, USA3Division of Plastic and Reconstructive Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, New York, USA
BACKGROUND: Enhanced Recovery After Surgery (ERAS) protocols have been applied to many surgical procedures. However, there is limited data following ERAS protocols with same-day discharge in breast reconstruction. This study evaluates the safety and outcomes following same-day discharge in tissue expander-based immediate breast reconstruction (TE-IBR) patients and oncoplastic breast reconstruction patients.
METHODS: A single-institution retrospective review of TE-IBR patients from 2017 to 2022 and oncoplastic breast reconstruction patients from 2014 to 2022 were included. Patients were divided by procedure and recovery pathway: Group 1 (TE-IBR, traditional overnight admission), Group 2 (TE-IBR, same-day discharge ERAS), Group 3 (oncoplastic, traditional overnight admission), and Group 4 (oncoplastic, same-day discharge ERAS). Group 1 and 2 were subdivided by implant location: Group 1a (pre-pectoral) and 1b (sub-pectoral); Group 2a (pre-pectoral) and 2b (sub-pectoral). Patient demographics, comorbidities, complications, and reoperations were recorded. Reoperation was defined as any unplanned operation due to complications. Postoperative complications and subsequent reoperations were followed for 30 days post-operation.
RESULTS: 220 patients were included: 160 TE-IBR patients (91, Group 1; 69, Group 2) and 60 oncoplastic breast reconstruction patients (8, Group 3; 52 Group 4).There were no significant differences in demographics and comorbidities between Group 1 and Group 2. Group 2 had higher rate of pre-pectoral TE placement (69.6% vs 27.5%, p < 0.001) and ADM use (p <0.001) compared to Group 1. Group 3 had a higher average BMI than Group 4 (37.6 vs 32.2, p <0.022).Group 2 had a significantly higher rate of seroma formation compared to Group 1 (21.7% vs 6.6%, p = 0.005). There was no significant difference between the two groups for rates of infection, hematoma, skin necrosis, wound dehiscence, fat necrosis, or implant loss. Comparison between groups and subgroups found no difference in reoperations. Notably, no patients in same-day discharge group required hospital admission.Comparing Group 3 to Group 4 showed no significant difference in rate of complications or in rate of reoperations.Early 90-day postoperative data confirms our data with no significant difference in hematomas, implant loss, or reoperations between any groups.
CONCLUSIONS: Many surgical subspecialities have successfully adopted ERAS protocols into their patient care and have shown both its safety and feasibility. Our research shows that same-day discharge in both TE-IBR and oncoplastic breast reconstruction does not increase risk for major complications or reoperations.
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