From the Renaissance School of Medicine at Stony Brook University, Stony Brook, NY.
Plastic Surgery, Geisinger Medical Center, Danville, PA.
Ann Plast Surg. 2023 Jun 1;90(6S Suppl 5):S538-S542. doi: 10.1097/SAP.0000000000003492. Epub 2023 Mar 2.
Data after enhanced recovery after surgery (ERAS) with same-day discharge in breast reconstruction is limited. This study evaluates early postoperative outcomes after same-day discharge in tissue-expander immediate breast reconstruction (TE-IBR) and oncoplastic breast reconstruction.
A single-institution retrospective review of TE-IBR patients from 2017 to 2022 and oncoplastic breast reconstruction patients from 2014 to 2022 was performed. Patients were divided by procedure and recovery pathway: group 1 (TE-IBR, overnight admission), group 2 (TE-IBR, ERAS), group 3 (oncoplastic, overnight admission), and group 4 (oncoplastic, ERAS). Groups 1 and 2 were subdivided by implant location: groups 1a (prepectoral) and 1b (subpectoral), and groups 2a (prepectoral) and 2b (subpectoral). Demographics, comorbidities, complications, and reoperations were analyzed.
A total of 160 TE-IBR patients (group 1, 91; group 2, 69) and 60 oncoplastic breast reconstruction patients (group 3, 8; group 4, 52) were included. Of the 160 TE-IBR patients, 73 underwent prepectoral reconstruction (group 1a, 25; group 2a, 48), and 87 underwent subpectoral reconstruction (group 1b, 66; group 2b, 21). There were no differences in demographics and comorbidities between groups 1 and 2. Group 3 had a higher average body mass index than group 4 (37.6 vs 32.2, P = 0.022). There was no significant difference between groups 1a and 2a or between groups 1b and 2b in rates of for rates of infection, hematoma, skin necrosis, wound dehiscence, fat necrosis, implant loss, or reoperations. Group 3 and group 4 showed no significant difference in any complications or in reoperations. Notably, no patients in same-day discharge groups required unplanned hospital admission.
Many surgical subspecialities have successfully adopted ERAS protocols into their patient care and have shown both its safety and feasibility. Our research shows that same-day discharge in both TE-IBR and oncoplastic breast reconstruction does not increase risk for major complications or reoperations.
在乳房重建中采用加速康复（ERAS）并实现当日出院的相关数据较为有限。本研究评估了即刻乳房重建（TE-IBR）和肿瘤整形乳房重建中当日出院后的早期术后结果。
对 2017 年至 2022 年间的 TE-IBR 患者和 2014 年至 2022 年间的肿瘤整形乳房重建患者进行了单机构回顾性研究。根据手术和康复途径对患者进行分组：第 1 组（TE-IBR，过夜入院）、第 2 组（TE-IBR，ERAS）、第 3 组（肿瘤整形，过夜入院）和第 4 组（肿瘤整形，ERAS）。第 1 组和第 2 组根据植入物位置进一步细分：第 1a 组（胸肌前）和第 1b 组（胸肌后），以及第 2a 组（胸肌前）和第 2b 组（胸肌后）。分析了患者的人口统计学、合并症、并发症和再次手术情况。
共纳入 160 例 TE-IBR 患者（第 1 组 91 例，第 2 组 69 例）和 60 例肿瘤整形乳房重建患者（第 3 组 8 例，第 4 组 52 例）。在 160 例 TE-IBR 患者中，73 例行胸肌前重建（第 1a 组 25 例，第 2a 组 48 例），87 例行胸肌后重建（第 1b 组 66 例，第 2b 组 21 例）。第 1 组和第 2 组在人口统计学和合并症方面无差异。第 3 组的平均体重指数高于第 4 组（37.6 比 32.2，P=0.022）。第 1a 组和第 2a 组或第 1b 组和第 2b 组之间的感染、血肿、皮肤坏死、伤口裂开、脂肪坏死、植入物丢失或再次手术的发生率无显著差异。第 3 组和第 4 组在任何并发症或再次手术方面无显著差异。值得注意的是，当日出院组中没有患者需要非计划性住院。
许多外科亚专科已成功将 ERAS 方案纳入其患者护理中，且证实了其安全性和可行性。我们的研究表明，TE-IBR 和肿瘤整形乳房重建中的当日出院并不会增加主要并发症或再次手术的风险。
