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Implementing Our Microsurgical Breast Reconstruction Enhanced Recovery after Surgery Pathway

Consensus Obstacles and Recommendations

Stone, Jill P., MD, FRCSC*; Siotos, Charalampos, MD*; Sarmiento, Samuel, MD, MPH, MBA*; Temple-Oberle, Claire, MD, MSc, FRCSC; Aliu, Oluseyi, MD*; Cooney, Damon S., MD, PhD*; Broderick, Kristen P., MD*; Sacks, Justin M., MD, MBA*; Manahan, Michele A., MD*; Rosson, Gedge D., MD*

Plastic and Reconstructive Surgery – Global Open: January 4, 2019 - Volume Latest Articles - Issue - p
doi: 10.1097/GOX.0000000000001855
Latest Articles: PDF Only

Summary: Enhanced recovery after surgery pathways are well established in other surgical specialties but are relatively new in plastic surgery. These guidelines focus on improving patient care by incorporating evidence-based recommendations. Length of stay is shorter, and overall hospital costs are lower without compromising patient satisfaction. When care is standardized, ambiguity is removed and physician acceptance is improved. Yet, implementation can be challenging on an institutional level. The Johns Hopkins microsurgical breast reconstruction team identified areas of dogmatic dissonance during 3 focus groups to formalize an enhanced recovery pathway for microsurgical breast reconstruction. Six microsurgeons used nominal group technique to reach consensus. Four discussion points were identified: multidisciplinary buy-in, venous thromboembolism (VTE) chemophylaxis, early feeding, and dietary restrictions. Evidence-based recommendations and our enhanced recovery after surgery protocol are provided.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

From the *Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Md.

Department of Surgery, University of Calgary, Calgary, Alberta, Canada.

Published online 4 January 2019.

Received for publication April 27, 2018; accepted May 8, 2018.

Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors.

Gedge D. Rosson, MD, Plastic Surgery and Oncology, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD 21201, E-mail:

Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.