Advancing Outcomes in Plastic Surgery Patients with Immunonutrition and Pre-Operative Wellness Education
Corianne D. Rogers, MD, Leah Moravec, BS, Nancy M. Strange, RDN, CNSC, CD, Cameron L. Colgate, BS, William A. Wooden, MD, FACS.
Indiana University, Indianapolis, IN, USA.
Introduction: Pre-Operative Wellness, Enhanced Rapid Recovery (POWERR) is an evidence-based program designed for elective surgical patients. It is composed of patient care items, patient counseling, and immunonutrition supplements and has been shown to decrease complications and overall cost across multiple surgical specialties. Plastic surgery procedures, including breast surgery and panniculectomy, have a wide variety of complications that may be mitigated by pre-operative surgical optimization. The purpose of this study is to determine the effect of POWERR on post-operative outcomes in a subset of plastic surgery patients.
Methods: Patients undergoing elective breast surgery or panniculectomy between 2014 and 2017 were reviewed, during which time patients were given the option of receiving a POWERR toolkit. These toolkits included smoking cessation assistance, incentive spirometry, chlorhexidine baths, mupirocin, and immunonutrition shakes. Data points of interest included patient demographics, comorbidities, hospital length of stay (LOS), and surgical complications. Standardized surveys were completed perioperatively and patients were analyzed in intervention and control groups.
Results: 149 patients were identified: 46 received POWERR intervention, 103 were controls. Patient age, race, gender, smoking status, ASA, and diabetes diagnosis did not significantly differ between groups. The intervention group had a larger BMI (36.8 versus 32.6 kg/m2 control group, p=0.015). Poisson regression analysis showed intervention patients had 30% decreased LOS (p=0.006) and were 80% less likely to have wound dehiscence (p=0.197). There was no difference in SSI between groups.
Conclusion: POWERR demonstrates improvement in LOS and wound dehiscence. Pre-operative wellness programs provide a standardized method to improve plastic surgery outcomes.
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