术后加速康复方案可缩短基于组织扩张器的乳房重建术的住院时间并减少术后麻醉剂使用量。
Enhanced Recovery after Surgery Protocol Decreases Length of Stay and Postoperative Narcotic Use in Tissue Expander-based Breast Reconstruction.
作者信息
Taylor Jeremiah M, Moman Precious D, Chevalier Jose M, Tseng Charles Y, Festekjian Jaco H, Delong Michael R
机构信息
From the Division of Plastic Surgery, University of California Los Angeles, Los Angeles, Calif.
出版信息
Plast Reconstr Surg Glob Open. 2024 Jun 6;12(6):e5879. doi: 10.1097/GOX.0000000000005879. eCollection 2024 Jun.
BACKGROUND
Enhanced recovery after surgery (ERAS) protocols have demonstrated success in reducing hospital stay and opioid consumption, but are less well studied in patients undergoing tissue expander-based breast reconstruction (TEBR). This study evaluates the effectiveness of an ERAS postoperative protocol for TEBR at a high-volume center.
METHODS
All patients undergoing immediate tissue expander reconstruction after the introduction of ERAS were prospectively included from April 2019 to June 2023. An equivalent number of similar patients were retrospectively reviewed before this date as the non-ERAS control. Data included demographics, operative details, postoperative length of stay, inpatient and discharge narcotic quantities, inpatient pain assessments, postoperative radiation, and complications within 90 days.
RESULTS
There were 201 patients in each cohort with statistically similar demographics. Patients in the ERAS cohort were more likely to undergo prepectoral reconstruction (83.1% versus 4.5%, < 0.001), be discharged by day 1 (96.5% versus 70.2%, < 0.001) and consume lower inpatient milligram morphine equivalent (MME) median (79.8 versus 151.8, < 0.001). Seroma rates (17.4% versus 3.5%, < 0.001) and hematoma incidence (4.5% versus 0%, = 0.004) were higher in the ERAS cohort. Adjusting for implant location, ERAS was associated with a 60.7 MME reduction (β=-60.7, < 0.001) and a shorter inpatient duration by 0.4 days (β =-0.4, < 0.001). Additionally, prepectoral reconstruction significantly decreased MME (β=-30.9, = 0.015) and was the sole predictor of seroma development (odds ratio = 5.2, = 0.009).
CONCLUSIONS
ERAS protocols significantly reduce opioid use and hospital stay after TEBR.
背景
术后加速康复（ERAS）方案已证明在缩短住院时间和减少阿片类药物使用方面取得成功，但在接受组织扩张器乳房重建术（TEBR）的患者中研究较少。本研究评估了一家大型中心实施的ERAS术后方案对TEBR的有效性。
方法
前瞻性纳入2019年4月至2023年6月期间所有在引入ERAS后接受即刻组织扩张器重建的患者。在此日期之前，回顾性审查数量相当的类似患者作为非ERAS对照组。数据包括人口统计学资料、手术细节、术后住院时间、住院期间和出院时的麻醉药品用量、住院期间疼痛评估、术后放疗以及90天内的并发症。
结果
每个队列有201例患者，人口统计学资料在统计学上相似。ERAS队列中的患者更有可能接受胸肌前重建（83.1%对4.5%，<0.001），在第1天出院（96.5%对70.2%，<0.001），住院期间吗啡毫克当量（MME）中位数较低（79.8对151.8，<0.001）。ERAS队列中的血清肿发生率（17.4%对3.5%，<0.001）和血肿发生率（4.5%对0%，=0.004）较高。调整植入位置后，ERAS与MME减少60.7相关（β=-60.7，<0.001），住院时间缩短0.4天（β=-0.4，<0.001）。此外，胸肌前重建显著降低了MME（β=-30.9，=0.015），并且是血清肿发生的唯一预测因素（比值比=5.2，=0.009）。
结论
ERAS方案显著减少了TEBR后的阿片类药物使用和住院时间。
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