Enhanced Recovery After Surgery Pathway for Microsurgical Breast Reconstruction: a Systematic Review and Meta-Analysis
Mohamad E. Sebai, MBBS, Charalampos Siotos, MD, Rachael Payne, BS, Stella M. Seal, MLS, Kristen Broderick, MD, Mehran Habibi, M.D., MBa, Michele A. Manahan, MD, Carisa M. Cooney, MPH, Gedge D. Rosson, MD.
The Johns Hopkins Hosptial, Baltimore, MD, USA.
PURPOSE: Enhanced Recovery After Surgery pathway (ERAS) was introduced in 1997 as a multimodal approach to improve postoperative preventable harm and to shorten hospital length of stay (LOS). However, there is yet no widely accepted ERAS for microsurgical breast reconstruction (MBR). This study aims to conduct a systematic review and a meta-analysis of the current literature on ERAS for MBR in regards to postoperative LOS and morbidity.
METHODS: We searched PubMed, Embase, Cochrane, Scopus and Web of Science for all studies published prior to June 2016 that contain original data investigating ERAS in MBR in relation to postoperative LOS and morbidity. Studies found were screened using eligibility criteria previously agreed upon. Meta-analysis, odds ratio and 95% confidence interval were used to pool acquired data.
RESULTS: The initial search identified 87 studies. Two independent screeners identified four original articles, with a pooled population of 676 patients. ERAS LOS was reported in three studies to be lower when compared to the previous protocols, from 6.6 to 3.9 days (p<0.001), 7.4 to 6.2 days (p<0.001), and 6.2 to 3.1 days (p<0.001).Two studies were pooled for the meta-analysis of postoperative morbidity, which suggested that ERAS was not associated with changes in 30 days postoperative morbidity; 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: Our review suggests that ERAS in MBR is associated with lower LOS. The meta-analysis suggests that ERAS is not associated with increased postoperative morbidity.
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