American Association of Plastic Surgeons

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Use of Enhanced Recovery After Surgery (ERAS) Protocol for Immediate Sub-muscular Breast Reconstruction after Outpatient Mastectomy is Safe and Significantly Reduces Health System Costs
Ryan Kunkle, MD, Christopher Demas, MD, Jeffrey Wu, MD, Gregory Borah, MD DMD FACS, Stephanie Fine, MD.
University of New Mexico Medical School, Albuquerque, NM, USA.

Introduction: This study retrospectively compared the 30-day complication rates in patients undergoing mastectomy with immediate sub-pectoral breast reconstruction with implant with ERAS protocol in an ambulatory surgery center setting versus standard inpatient hospital postsurgical protocol. Composite hospital costs were compared for both surgical approaches.
Methods:
All patients (495 patients) undergoing mastectomy between 2014 to 2016 at our university hospital were reviewed. 70 women met criteria for mastectomy and immediate sub-pectoral implant breast reconstruction. Group 1): same day surgery center mastectomy ERAS (SDM) group (36 patients). Group 2): planned overnight admission (POA) group (32 patients). POA cases were performed in hospital OR. Summative cost data of direct and indirect expenses of both groups were retrieved using hospital accounting systems. 
Results:
All ERAS Same Day Mastectomy (SDM) patients all went home day of surgery.
Planned Overnight Admission (POA) hospital stays 1 night (85%), 2 nights (12%), 4 nights (3%)
Post-operative complication rates were similar and not statistically different.
Hospital cost data showed statistically significant differences: Direct: SDM = $14.1K ; POA = $19.3K; savings $5.1K (p=0.002). Indirect costs were reduced as well: SDM = $1.9K; POA = $3.6K; saved $1.7K (p=0.015)
Conclusions:
There were no statistical differences in 30-day complication rates between ERAS same day discharge patients versus in hospital surgery with planned overnight
admission.
Statistically significant cost savings of 31% were demonstrated with use of ERAS principles and same day surgery.
Social issues were principal reason patients could not be safely discharged from an ambulatory setting and required a planned admission.


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