An Enhanced Recovery after Surgery Pathway for Microvascular Breast Reconstruction Is Safe and Effective
Background:. The aim of this study was to develop, implement, and evaluate a standardized perioperative enhanced recovery after surgery (ERAS) clinical care pathway in microsurgical abdominal-based breast reconstruction. Methods:. Development of a clinical care pathway was informed by the latest ERA...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2018-01-01
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| Series: | Plastic and Reconstructive Surgery, Global Open |
| Online Access: | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000001634 |
| _version_ | 1828976109064028160 |
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| author | Arezoo Astanehe, MD, MSc, PhD Claire Temple-Oberle, MD, MSc Markus Nielsen William de Haas, MD Robert Lindsay, MD Jennifer Matthews, MD David C McKenzie, MD Justin Yeung, MD Christiaan Schrag, MD |
| author_facet | Arezoo Astanehe, MD, MSc, PhD Claire Temple-Oberle, MD, MSc Markus Nielsen William de Haas, MD Robert Lindsay, MD Jennifer Matthews, MD David C McKenzie, MD Justin Yeung, MD Christiaan Schrag, MD |
| author_sort | Arezoo Astanehe, MD, MSc, PhD |
| collection | DOAJ |
| description | Background:. The aim of this study was to develop, implement, and evaluate a standardized perioperative enhanced recovery after surgery (ERAS) clinical care pathway in microsurgical abdominal-based breast reconstruction.
Methods:. Development of a clinical care pathway was informed by the latest ERAS guideline for breast reconstruction. Key features included shortened preoperative fasting, judicious fluids, multimodal analgesics, early oral nutrition, early Foley catheter removal, and early ambulation. There were 3 groups of women in this cohort study: (1) traditional historical control; (2) transition group with partial implementation; and (3) ERAS. Narcotic use, patient-reported pain scores, antiemetic use, time to regular diet, time to first walk, hospital length of stay, and 30-day postoperative complications were compared between the groups.
Results:. After implementation of the pathway, the use of parenteral narcotics was reduced by 88% (traditional, 112 mg; transition, 58 mg; ERAS, 13 mg; P < 0.0001), with no consequent increase in patient-reported pain. Patients in the ERAS cohort used less antiemetics (7.0, 5.3, 2.2 doses, P < 0.0001), returned to normal diet 19 hours earlier (46, 39, 27 hours, P < 0.0001), and walked 25 hours sooner (75, 70, 50 hours, P < 0.0001). Overall, hospital length of stay was reduced by 2 days in the ERAS cohort (6.6, 5.6, 4.8 days, P < 0.0001), without an increase in rates of major complications (9.5%, 10.1%, 8.3%, P = 0.9).
Conclusions:. A clinical care pathway in microsurgical breast reconstruction using the ERAS Society guideline promotes successful early recovery. |
| first_indexed | 2024-12-14T14:32:31Z |
| format | Article |
| id | doaj.art-591e02a229914fc0aeadccdd4f158702 |
| institution | Directory Open Access Journal |
| issn | 2169-7574 |
| language | English |
| last_indexed | 2024-12-14T14:32:31Z |
| publishDate | 2018-01-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Plastic and Reconstructive Surgery, Global Open |
| spelling | doaj.art-591e02a229914fc0aeadccdd4f1587022022-12-21T22:57:46ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742018-01-0161e163410.1097/GOX.0000000000001634201801000-00001An Enhanced Recovery after Surgery Pathway for Microvascular Breast Reconstruction Is Safe and EffectiveArezoo Astanehe, MD, MSc, PhD0Claire Temple-Oberle, MD, MSc1Markus Nielsen2William de Haas, MD3Robert Lindsay, MD4Jennifer Matthews, MD5David C McKenzie, MD6Justin Yeung, MD7Christiaan Schrag, MD8From the Division of Plastic and Reconstructive Surgery, University of Calgary, Calgary, Alberta, Canada.From the Division of Plastic and Reconstructive Surgery, University of Calgary, Calgary, Alberta, Canada.From the Division of Plastic and Reconstructive Surgery, University of Calgary, Calgary, Alberta, Canada.From the Division of Plastic and Reconstructive Surgery, University of Calgary, Calgary, Alberta, Canada.From the Division of Plastic and Reconstructive Surgery, University of Calgary, Calgary, Alberta, Canada.From the Division of Plastic and Reconstructive Surgery, University of Calgary, Calgary, Alberta, Canada.From the Division of Plastic and Reconstructive Surgery, University of Calgary, Calgary, Alberta, Canada.From the Division of Plastic and Reconstructive Surgery, University of Calgary, Calgary, Alberta, Canada.From the Division of Plastic and Reconstructive Surgery, University of Calgary, Calgary, Alberta, Canada.Background:. The aim of this study was to develop, implement, and evaluate a standardized perioperative enhanced recovery after surgery (ERAS) clinical care pathway in microsurgical abdominal-based breast reconstruction. Methods:. Development of a clinical care pathway was informed by the latest ERAS guideline for breast reconstruction. Key features included shortened preoperative fasting, judicious fluids, multimodal analgesics, early oral nutrition, early Foley catheter removal, and early ambulation. There were 3 groups of women in this cohort study: (1) traditional historical control; (2) transition group with partial implementation; and (3) ERAS. Narcotic use, patient-reported pain scores, antiemetic use, time to regular diet, time to first walk, hospital length of stay, and 30-day postoperative complications were compared between the groups. Results:. After implementation of the pathway, the use of parenteral narcotics was reduced by 88% (traditional, 112 mg; transition, 58 mg; ERAS, 13 mg; P < 0.0001), with no consequent increase in patient-reported pain. Patients in the ERAS cohort used less antiemetics (7.0, 5.3, 2.2 doses, P < 0.0001), returned to normal diet 19 hours earlier (46, 39, 27 hours, P < 0.0001), and walked 25 hours sooner (75, 70, 50 hours, P < 0.0001). Overall, hospital length of stay was reduced by 2 days in the ERAS cohort (6.6, 5.6, 4.8 days, P < 0.0001), without an increase in rates of major complications (9.5%, 10.1%, 8.3%, P = 0.9). Conclusions:. A clinical care pathway in microsurgical breast reconstruction using the ERAS Society guideline promotes successful early recovery.http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000001634 |
| spellingShingle | Arezoo Astanehe, MD, MSc, PhD Claire Temple-Oberle, MD, MSc Markus Nielsen William de Haas, MD Robert Lindsay, MD Jennifer Matthews, MD David C McKenzie, MD Justin Yeung, MD Christiaan Schrag, MD An Enhanced Recovery after Surgery Pathway for Microvascular Breast Reconstruction Is Safe and Effective Plastic and Reconstructive Surgery, Global Open |
| title | An Enhanced Recovery after Surgery Pathway for Microvascular Breast Reconstruction Is Safe and Effective |
| title_full | An Enhanced Recovery after Surgery Pathway for Microvascular Breast Reconstruction Is Safe and Effective |
| title_fullStr | An Enhanced Recovery after Surgery Pathway for Microvascular Breast Reconstruction Is Safe and Effective |
| title_full_unstemmed | An Enhanced Recovery after Surgery Pathway for Microvascular Breast Reconstruction Is Safe and Effective |
| title_short | An Enhanced Recovery after Surgery Pathway for Microvascular Breast Reconstruction Is Safe and Effective |
| title_sort | enhanced recovery after surgery pathway for microvascular breast reconstruction is safe and effective |
| url | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000001634 |
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