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Enhanced Recovery after Surgery Pathway for Microsurgical Breast Reconstruction: A Systematic Review and Meta-Analysis

Sebai, Mohamad E., M.D.; Siotos, Charalampos, M.D.; Payne, Rachael M., B.S.; Stone, Jill P., M.D.; Seal, Stella M., M.L.S.; Habibi, Mehran, M.D.; Broderick, Kristen, M.D.; Sacks, Justin M., M.D., M.B.A.; Manahan, Michele A., M.D.; Rosson, Gedge D., M.D.

Plastic and Reconstructive Surgery: March 2019 - Volume 143 - Issue 3 - p 655-666
doi: 10.1097/PRS.0000000000005300
Breast: Original Articles
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Patient Safety CME

Background: The enhanced recovery after surgery pathway was introduced in 1997 as a multimodal approach to reduce preventable postoperative harm and shorten hospital length of stay. However, there is yet no widely accepted enhanced recovery after surgery protocol for microsurgical breast reconstruction. The authors conducted a systematic review and meta-analysis of the current literature on enhanced recovery after surgery for microsurgical breast reconstruction with regard to postoperative length of stay and morbidity.

Methods: The PubMed, Embase, Cochrane, Scopus, and Web of Science databases were searched for all studies published before June of 2016 containing original data on enhanced recovery after surgery in microsurgical breast reconstruction in relation to postoperative length of stay and morbidity. Studies were screened using eligibility criteria. Meta-analysis, odds ratio, and 95 percent confidence interval were used to pool acquired data.

Results: The initial search identified 86 studies. Two independent screeners identified four original articles with a total of 676 patients. Length of stay was significantly shorter for patients on an enhanced recovery after surgery pathway (mean difference, −1.23; 95 percent CI, −1.50 to −0.96; p < 0.001; I2 = 0 percent; random effects model). Enhanced recovery was not associated with changes in 30-day postoperative morbidity; specifically, no significant difference was observed in rates of partial flap loss (p = 0.44), total flap loss (p = 0.91), breast hematoma (p = 0.69), donor-site infection (p = 0.53), urinary tract infection (p = 0.29), and pneumonia (p = 0.42).

Conclusion: The authors’ review suggests that enhanced recovery after surgery in microsurgical breast reconstruction is associated with a reduced length of stay, and is not associated with increased postoperative morbidity.

Patient Safety CME.

New York, N.Y.; and Baltimore, Md.

From the Department of Surgery, Montefiore Medical Center-Albert Einstein College of Medicine; and Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital.

Received for publication July 10, 2017; accepted July 23, 2018.

Presented at the 96th Annual Meeting of the American Association of Plastic Surgeons, in Austin, Texas, May 25 through 28, 2017; and poster presentation at The Johns Hopkins Patient Safety Summit, in Baltimore, Maryland, January 14, 2016.

Disclosure:None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this article. No funding was received for this work.

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Gedge D. Rosson, M.D., Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, McElderry 8161, 601 North Caroline Street, Baltimore, Md. 21287,

Copyright © 2018 by the American Society of Plastic Surgeons