Ambulatory latissimus dorsi flap breast reconstruction: A prospective cohort study of an enhanced recovery after surgery (ERAS) protocol

Michael J Stein; Simon G Frank; Anne Lui; Tinghua Zhang; Jing Zhang

doi:10.1016/j.bjps.2019.06.039

Ambulatory latissimus dorsi flap breast reconstruction: A prospective cohort study of an enhanced recovery after surgery (ERAS) protocol

J Plast Reconstr Aesthet Surg. 2019 Dec;72(12):1950-1955. doi: 10.1016/j.bjps.2019.06.039. Epub 2019 Jul 17.

Authors

Michael J Stein¹, Simon G Frank¹, Anne Lui², Tinghua Zhang³, Jing Zhang⁴

Affiliations

¹ Division of Plastic and Reconstructive Surgery, University of Ottawa, Ottawa, Ontario, Canada.
² Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada.
³ Ottawa Health Research Institute (OHRI), The Ottawa Hospital, Ottawa, Ontario, Canada.
⁴ Division of Plastic and Reconstructive Surgery, University of Ottawa, Ottawa, Ontario, Canada. Electronic address: jzhang1@toh.ca.

PMID: 31488381
DOI: 10.1016/j.bjps.2019.06.039

Abstract

Purpose: Enhanced recovery after surgery (ERAS) protocols improve quality of recovery and decrease length of stay for patients undergoing both alloplastic and autologous breast reconstruction. Their use in latissimus dorsi (LD) flap reconstruction has not been well established. The purpose of this study was to compare postoperative outcomes, length of stay, and total costs in a prospectively enrolled group of patients who underwent LD flap breast reconstruction using an ERAS protocol to those of a retrospective cohort of patients who were treated with a traditional recovery after surgery (TRAS) protocol.

Methods: In a prospective cohort study conducted from 2016 to 2019, an ERAS protocol was implemented for patients undergoing LD flap breast reconstruction. The primary outcome was 24-h discharge, and secondary outcomes were readmission rate, complications, and quality of recovery. Outcomes of patients who underwent LD flap reconstruction with the ERAS protocol were compared with those of a retrospective cohort of patients who underwent LD flap reconstruction with TRAS protocols.

Results: Twenty patients enrolled in the ERAS group were compared with 58 patients in the TRAS group. Postoperatively, 100% of ERAS patients were discharged within 24 h (60% on the same day) as compared to 21% (9% on the same day) in the TRAS group (p<0.0001). Minor and major complication rates were similar (30% ERAS vs. 33% TRAS and 20% ERAS vs. 10% TRAS, respectively, p > 0.05). There was significant reduction in length of stay and total cost between the two groups (6.4 h vs. 58.5 h (p = 0.003) and $5,666.80 vs. $8890.25 (p = 0.0003), respectively).

Conclusions: Breast reconstruction with the LD flap can be performed safely and effectively in the ambulatory setting. The implementation of an ERAS protocol was successful in discharging all patients home within 24 h, and the expedited discharge was associated with an acceptable complication rate, reduced length of stay, and excellent quality of recovery. Conversion from TRAS to ERAS protocols was associated with $3,223.45 cost savings per patient.

Keywords: Ambulatory surgery; Breast reconstruction; Expedited discharge; Latissimus dorsi.

MeSH terms

Ambulatory Surgical Procedures / methods
Ambulatory Surgical Procedures / statistics & numerical data
Breast Neoplasms / surgery*
Case-Control Studies
Clinical Protocols
Costs and Cost Analysis
Enhanced Recovery After Surgery
Female
Humans
Length of Stay / statistics & numerical data
Mammaplasty / methods*
Mammaplasty / statistics & numerical data
Middle Aged
Patient Discharge / statistics & numerical data
Prospective Studies
Superficial Back Muscles / transplantation*
Surgical Flaps*