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TAP Blocks Reduce Hospital Stay and Costs in DIEP Flap Reconstruction: A Shift in Pain Management Strategy
Robert D. Sampson MD, MBA, Nicolas Oltean BS, Chiagoziem Okolo BS, Michael Awad BS, Duc T. Bui MD, Sami Khan MD
Division of Plastic and Reconstructive Surgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
Background: Deep inferior epigastric perforator (DIEP) flap breast reconstruction involves significant postoperative pain and resource utilization. Despite increasing use of transversus abdominis plane (TAP) blocks in ERAS protocols, data on their cost-effectiveness, particularly comparing unilateral versus bilateral procedures, remain limited.
Methods: We analyzed 129 patients (TAP: n=65; No-TAP: n=64) undergoing DIEP flap breast reconstruction at a single institution between 2012-2023 in this retrospective study. Outcomes included pain scores, hospital stay, and opioid consumption. Propensity score matching controlled for BMI, procedure laterality, and timing. Economic analysis incorporated inpatient costs, TAP block placement with standard bupivacaine/ropivacaine, analgesics, and pain management modalities.
Results: TAP block recipients showed significantly shorter hospital stays (4.58 vs. 5.45 days, p=0.0004). Initial pain scores were lower but not significant (3.63 vs. 4.50, p=0.25), with similar opioid consumption (46.98 vs. 50.43 mg IV morphine equivalents, p=0.78). TAP blocks replaced traditional pain management, with reduced PCA (4.6% vs. 59.4%) and epidural use (1.5% vs. 18.8%). Healthcare costs were lower in the TAP group ($17,540 vs. $20,350, p=0.003), a $2,810 (13.8%) reduction per patient. Cost savings were more pronounced for unilateral procedures (23.6% reduction) than bilateral procedures (6.6%), primarily due to greater hospital stay reduction in unilateral cases (27.2% vs. 11.7%).
Conclusion: This study demonstrates greater cost savings with TAP blocks in unilateral DIEP flap reconstructions. TAP blocks were associated with shorter hospital stays and reduced costs while maintaining effective analgesia. The notable difference in cost reduction between unilateral and bilateral procedures provides guidance for clinical decision-making. These findings support incorporating TAP blocks into ERAS protocols for DIEP flap breast reconstruction, representing a shift in perioperative management that preserves analgesic efficacy while reducing costs.
