Stone Jill P, Siotos Charalampos, Sarmiento Samuel, Temple-Oberle Claire, Aliu Oluseyi, Cooney Damon S, Broderick Kristen P, Sacks Justin M, Manahan Michele A, Rosson Gedge D
Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Md.
Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
Plast Reconstr Surg Glob Open. 2019 Jan 4;7(1):e1855. doi: 10.1097/GOX.0000000000001855. eCollection 2019 Jan.
Enhanced recovery after surgery pathways are well established in other surgical specialties but are relatively new in plastic surgery. These guidelines focus on improving patient care by incorporating evidence-based recommendations. Length of stay is shorter, and overall hospital costs are lower without compromising patient satisfaction. When care is standardized, ambiguity is removed and physician acceptance is improved. Yet, implementation can be challenging on an institutional level. The Johns Hopkins microsurgical breast reconstruction team identified areas of dogmatic dissonance during 3 focus groups to formalize an enhanced recovery pathway for microsurgical breast reconstruction. Six microsurgeons used nominal group technique to reach consensus. Four discussion points were identified: multidisciplinary buy-in, venous thromboembolism (VTE) chemophylaxis, early feeding, and dietary restrictions. Evidence-based recommendations and our enhanced recovery after surgery protocol are provided.
术后加速康复路径在其他外科专科中已得到充分确立，但在整形外科中相对较新。这些指南通过纳入循证建议来专注于改善患者护理。住院时间缩短，总体医院成本降低，同时不影响患者满意度。当护理标准化时，消除了模糊性并提高了医生的接受度。然而，在机构层面实施可能具有挑战性。约翰霍普金斯显微外科乳房重建团队在3个焦点小组中确定了教条式不一致的领域，以制定显微外科乳房重建的术后加速康复路径。六位显微外科医生使用名义群体技术达成共识。确定了四个讨论点：多学科支持、静脉血栓栓塞（VTE）化学预防、早期喂养和饮食限制。提供了循证建议和我们的术后加速康复方案。
