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J Reconstr Microsurg 2019; 35(08): 557-567
DOI: 10.1055/s-0039-1687916
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Reducing Length of Stay after Microsurgical Breast Reconstruction with a Standardized Postoperative Protocol

Matthew A. DelMauro
1   Department of Surgery, Division of Plastic Surgery, Northwell Health System, Manhasset, New York, United States
,
Kevin Chen
1   Department of Surgery, Division of Plastic Surgery, Northwell Health System, Manhasset, New York, United States
,
Alex Keller
2   Department of Surgery, Division of Plastic Surgery, Hofstra Northwell School of Medicine; Northwell Health System, Manhasset, New York, United States
› Author Affiliations
Further Information

Publication History

27 September 2018

04 March 2019

Publication Date:
01 May 2019 (online)

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Abstract

Background Despite widespread acceptance of enhanced recovery after surgery protocols in other surgical specialties, plastic surgery has been slow to adopt fast-track principles. Recently, however, studies have shown that patients undergoing microsurgical breast reconstruction may benefit from a comprehensive postoperative protocol.

Methods All microsurgical breast reconstructions with abdominal free flaps performed by the senior author (A.K.) at a single institution from June 2009 to December 2013 were reviewed. Demographic information (e.g., age, body mass index, and comorbidities), operative details (e.g., laterality, type of flap), and postoperative data (e.g., complications, length of stay) were collected from patients' medical records. The authors employed a universal comprehensive protocol that dictated all postoperative care as it relates to diet, ambulation, flap monitoring, anticoagulation, analgesia, venous thromboembolism, antibiotic prophylaxis, and discharge criteria.

Results During the study period, 161 patients underwent 289 free flaps. The average length of stay for all patients was 3.26 ± 1.19 days. The incidence of complications requiring return to the operating room was 4.35% (7 patients). The incidence of flap failure was 0.69% (2 of 289 flaps). Only one flap failure occurred after hospital discharge. Statistical analysis demonstrated that the presence of any complication requiring return to the operating room increased hospital course by an average of 1.37 days (p = 0.0027).

Conclusion The standardization of postoperative care for patients undergoing microsurgical breast reconstruction results in a short hospital length of stay without increasing the incidence of flap failure or postoperative complications requiring return to the operating room.

Keywords

breast reconstruction - enhanced recovery after surgery - DIEP flap

Financial Disclosure

Alex Keller has been a consultant to ViOptix, Inc. since 2005, the medical director from 2008 to 2015, and holds stock options in the company. Neither Matthew DelMauro nor Kevin Chen has any financial interest in any of the products, devices, or drugs mentioned in this manuscript.


Compliance with Ethical Standards

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


 

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