El-Jebaoui Jad, Awaida Cyril J, Bou-Merhi Joseph, Bernier Christina, Gagnon Alain, Aribert Marion, Saint-Cyr Michel, Harris Patrick G, Odobescu Andrei
University of Montreal, Montreal, Quebec, Canada.
Division of Plastic and Reconstructive Surgery, University of Montreal Hospital Center, Montreal, Quebec, Canada.
Plast Surg (Oakv). 2024 Mar 6:22925503241234935. doi: 10.1177/22925503241234935.
To improve patient outcomes amid reduced healthcare resources during the COVID-19 pandemic, a single Canadian cancer center implemented an Enhanced Recovery After Surgery (ERAS) protocol for autologous DIEP flap breast reconstruction. This retrospective cohort study included 100 consecutive patients undergoing microsurgical breast reconstruction with DIEP flaps using the ERAS protocol and 100 patients using a standard protocol. Primary outcomes were the hospital length of stay and opioid use. Secondary outcomes included postoperative complications, laxative and antiemetic consumption. In this study, 80% of the patients had immediate reconstruction, while the remaining patients received either delayed immediate or delayed reconstruction. Patients in the ERAS group had shorter hospital stays (2.8 vs 4.5 days; < 0.001) and lower total opioid use (50.2 vs 136.3 mg; < 0.001). This reduction was also observed when breaking down opiates per day of hospitalization (30.2 vs 18.2 mg; < 0.001), and in the first 24 postoperatively hours (35.7 vs 67.6 mg; < 0.001). The control group had a higher incidence of postoperative complications, including seroma, partial and total flap necrosis, compared to the ERAS group. However, readmission rates were similar between the two groups. Implementing the ERAS protocol for DIEP flap breast reconstruction can significantly reduce hospital length of stay and postoperative opioid requirements without increasing the risk of adverse events. This pattern holds true for immediate reconstructions with DIEP flaps.
为在新冠疫情期间医疗资源减少的情况下改善患者治疗效果，加拿大一家癌症中心针对自体腹壁下动脉穿支（DIEP）皮瓣乳房重建实施了强化术后康复（ERAS）方案。这项回顾性队列研究纳入了100例连续接受使用ERAS方案的DIEP皮瓣显微外科乳房重建的患者以及100例使用标准方案的患者。主要结局指标为住院时间和阿片类药物使用情况。次要结局指标包括术后并发症、泻药和止吐药的使用。在本研究中，80%的患者接受了即刻重建，其余患者接受了延迟即刻或延迟重建。ERAS组患者的住院时间更短（2.8天对4.5天；<0.001），阿片类药物总使用量更低（50.2毫克对136.3毫克；<0.001）。在按住院天数分解阿片类药物使用量时（30.2毫克对18.2毫克；<0.001）以及术后头24小时内（35.7毫克对67.6毫克；<0.001）也观察到了这种减少。与ERAS组相比，对照组术后并发症的发生率更高，包括血清肿、部分和全部皮瓣坏死。然而，两组的再入院率相似。对DIEP皮瓣乳房重建实施ERAS方案可显著缩短住院时间和降低术后阿片类药物需求量，且不会增加不良事件风险。这种模式在DIEP皮瓣即刻重建中也成立。
