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Improved Recovery Experience Achieved for Women Undergoing Implant-Based Breast Reconstruction Using an Enhanced Recovery after Surgery Model

Dumestre, Danielle O. M.D.; Webb, Carmen E. M.A.; Temple-Oberle, Claire M.D., M.Sc.

Plastic and Reconstructive Surgery: March 2017 - Volume 139 - Issue 3 - p 550–559
doi: 10.1097/PRS.0000000000003056
Breast: Original Articles
Discussion

Background: Enhanced recovery after surgery was compared with traditional recovery after surgery for postmastectomy alloplastic breast reconstruction.

Methods: Length of stay, emergency room visits, and complications within 30 days of surgery were compared among three groups: traditional recovery after surgery, transition (some elements of enhanced recovery protocol, not transitioned to outpatient care), and enhanced recovery after surgery (day surgery, provided with standardized perioperative education and multimodal analgesia). Prospective data collection allowed quality-of-recovery assessment using a validated questionnaire for enhanced recovery/transition groups. Results were statistically analyzed (analysis of variance/chi-square).

Results: The traditional recovery, transition, and enhanced recovery cohorts comprised 29, 11, and 29 patients, respectively. No significant differences were present regarding age, smoking status, preoperative radiation, single stage direct-to-implant versus tissue expander, bilateral versus unilateral surgery, or immediate versus delayed reconstruction among groups. Average length of stay was 1.6 nights in both the traditional recovery and transition groups, compared with 0 nights in the enhanced recovery group (p < 0.001). Enhanced recovery patients had less severe pain (p = 0.02) and nausea (p = 0.01), and better enjoyed their food (p = 0.0002) and felt more rested (p = 0.02) than their transition counterparts. There were no differences in the number of emergency room visits among the three groups (p = 0.88). There was no difference in the rate of hematoma (p = 0.36), infection requiring intravenous antibiotics (p = 0.36), or infection requiring explantation (p = 0.36) among the three groups.

Conclusion: An enhanced recovery protocol for alloplastic breast reconstruction treated patients safely, with improved patient satisfaction and same-day discharge and with no increase in complications.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Calgary, Alberta, Canada

From the Department of Surgery, Division of Plastic and Reconstructive Surgery, and the Tom Baker Cancer Centre, University of Calgary.

Received for publication May 23, 2016; accepted September 2, 2016.

Presented at the 69th Annual Meeting of the Canadian Society of Plastic Surgeons, in Victoria, British Columbia, Canada, June 2 through 6, 2015.

Disclosure:Dr. Temple-Oberle has received an advisory board honorarium from Allergan as well as unrestricted education funds from Allergan and Acelity. The authors have no financial interest to declare in relation to the content of this article.

Claire Temple-Oberle, M.D., M.Sc., Department of Surgery, Division of Plastic Surgery, Tom Baker Cancer Centre, 1331 29 Street NW, Calgary, Alberta T2A 4N2, Canada, claire.temple-oberle@ahs.ca

©2017American Society of Plastic Surgeons