Queen's University, Canada.
University of Ottawa, Canada; The Ottawa Hospital, Division of Plastic Surgery, Canada.
J Plast Reconstr Aesthet Surg. 2023 Oct;85:252-263. doi: 10.1016/j.bjps.2023.06.075. Epub 2023 Jul 6.
Recent studies have successfully employed perioperative protocols and Enhanced Recovery After Surgery (ERAS) protocols to promote and increase the range of breast reconstruction procedures performed in ambulatory settings. This systematic review aims to identify the common perioperative protocol items associated with successful ambulatory breast reconstruction.
A systematic review of electronic databases (Ovid Medline, EMBASE, and Cochrane) was conducted. Studies that described the perioperative care protocol for postmastectomy breast reconstruction in ambulatory settings (discharge within 24 h) were included. Two reviewers independently screened the literature and extracted the data. Risk of bias was assessed with the National Heart, Lung, and Blood Institute quality tool. The perioperative protocol details, type of reconstruction, information regarding patient selection criteria, successful discharge rates, and complication rates were extracted.
Twelve studies were included in the systematic review, with 1484 patients undergoing ambulatory breast reconstruction with a well-defined perioperative protocol. Sixteen perioperative items were identified. The most discussed items were preoperative counseling (11/12), preoperative and intraoperative multimodal analgesia (11/12), and postoperative analgesia (10/12). Our recommendation includes two new items and seven modified items compared to previous ERAS guidelines. Overall, the mean number of items was 9.22 in same-day discharge and 6.75 in 24-h discharge (P = 0.169). 78.4% of the patients (1123 of 1433) were successfully discharged within 24 h. No studies identified an increase in readmission or complications with ambulatory discharge.
Sixteen core items were defined for a successful perioperative ERAS protocol for 24-h discharge breast reconstruction. Implementing perioperative protocols can facilitate under-24-h discharge for alloplastic and autologous surgery.
最近的研究成功地采用了围手术期方案和术后快速康复（ERAS）方案，以促进和增加在门诊环境中进行的乳房重建手术范围。本系统评价旨在确定与门诊乳房重建成功相关的常见围手术期方案项目。
对电子数据库（Ovid Medline、EMBASE 和 Cochrane）进行系统评价。纳入描述门诊乳房重建（24 小时内出院）围手术期护理方案的研究。两名评审员独立筛选文献并提取数据。使用美国国立心肺血液研究所质量工具评估偏倚风险。提取围手术期方案细节、重建类型、患者选择标准信息、成功出院率和并发症发生率。
系统评价纳入了 12 项研究，共有 1484 例患者接受了有明确围手术期方案的门诊乳房重建。确定了 16 个围手术期项目。讨论最多的项目是术前咨询（12/12）、术前和术中多模式镇痛（12/12）和术后镇痛（10/12）。与之前的 ERAS 指南相比，我们的建议包括两项新的项目和七项修改的项目。总体而言，同一天出院的患者平均项目数为 9.22 项，24 小时出院的患者平均项目数为 6.75 项（P=0.169）。78.4%（1123/1433）的患者在 24 小时内成功出院。没有研究表明门诊出院会增加再入院率或并发症。
确定了 16 个核心项目，用于 24 小时出院乳房重建的成功围手术期 ERAS 方案。实施围手术期方案可以促进所有oplastic 和自体手术在 24 小时内出院。
