Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
J Reconstr Microsurg. 2022 Jun;38(5):371-377. doi: 10.1055/s-0041-1733993. Epub 2021 Aug 28.
Enhanced recovery after surgery (ERAS) protocols are effective in decreasing hospital length of stay and inpatient opioid consumption. Implementation of these protocols in abdominally based breast reconstruction has been successful. When a patient is a poor candidate for abdominally based flaps a popular secondary option is the profunda artery perforator (PAP) flap. We present our experience with implementation of our ERAS protocol in patients treated with PAP flaps for breast reconstruction.
Retrospective review of patients treated with autologous breast reconstruction using PAP flaps before and after ERAS implementation were performed. Patient characteristics, postoperative oral morphine equivalents (OMEs), and flap data were collected.
A total of 87 patients were included in this study (58 patients in pre-ERAS and 29 patients in ERAS group). There was no statistical difference in patient age, comorbidities, smoking, and radiation between two groups. The ERAS group had statistically lower hospital length of stay (2.6 vs. 3.8 days), procedure time (315 vs. 433 minutes), postoperative day 0 (54.8 vs. 96.3), postoperative day 1 (29.9 vs. 57.7), and total opioid consumption (103.7 vs. 192.1). There was no statistical difference in average pain scores between two groups. Multivariate analysis revealed that procedure time significantly increased the amount of opioid consumption while ERAS implementation significantly reduced LOS and opioid consumption.
Use of an ERAS protocol in PAP flap breast reconstruction has not been previously studied. Our work shows that ERAS implementation in PAP flap breast reconstruction significantly reduces inpatient opioid use and length of hospital stay.
术后加速康复（ERAS）方案可有效减少住院时间和住院内阿片类药物的使用量。这些方案在腹部来源的乳房重建中已得到成功实施。当患者不适合进行腹部皮瓣乳房重建时，一种常用的替代方案是穿支皮瓣（PAP）。我们报告了在接受 PAP 皮瓣乳房重建的患者中实施我们的 ERAS 方案的经验。
对接受 PAP 皮瓣乳房重建的患者进行了 ERAS 实施前后的回顾性研究。收集了患者特征、术后口服吗啡等效物（OMEs）和皮瓣数据。
共纳入 87 例患者（ERAS 实施前 58 例，ERAS 组 29 例）。两组患者的年龄、合并症、吸烟和放疗均无统计学差异。ERAS 组的住院时间（2.6 天 vs. 3.8 天）、手术时间（315 分钟 vs. 433 分钟）、术后第 0 天（54.8 分 vs. 96.3 分）、术后第 1 天（29.9 分 vs. 57.7 分）和总阿片类药物用量（103.7 毫克 vs. 192.1 毫克）均显著降低。两组患者的平均疼痛评分无统计学差异。多变量分析显示，手术时间显著增加了阿片类药物的使用量，而 ERAS 方案的实施显著减少了住院时间和阿片类药物的使用量。
ERAS 方案在 PAP 皮瓣乳房重建中尚未被研究过。我们的工作表明，在 PAP 皮瓣乳房重建中实施 ERAS 方案可显著减少住院期间阿片类药物的使用量和住院时间。
