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Post-operative Day #1 (POD1) Discharge In Deep Inferior Epigastric Perforator (DIEP) Flap Breast Reconstruction
Marion Tapp, MD¹, Mary Duet, BS¹, Thomas Steele, MD¹, Robert Gallagher, BS², Sarah Pennypacker, BS¹, Bennett Calder, MD¹, Michael Robinson, MD¹.
¹Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA, ²Des Moines University College of Osteopathic Medicine, Des Moines, IA, USA.

Purpose:The necessity of longer admissions following autologous breast reconstruction has come into question. Our institution has progressively shortened the length of stay following DIEP flap reconstruction and begun discharging patients on POD1. The purpose of this study is to document our experience with POD1 discharges while also identifying pre-operative and intra-operative factors that may identify patients as candidates for earlier discharge. Methods:An IRB-approved, retrospective review of patients undergoing DIEP flap breast reconstruction from January 2019-March 2022 at Atrium Health was completed consisting of 510 patients and 846 DIEP flaps. Patient demographics, medical history, operative course and postoperative complications were collected. R statistical software was used for statistical analysis, including summary statistics and Welch’s two-sample T-tests. Results: 23 Patients totaling 33 DIEP flaps were discharged on POD1 following reconstruction. Standard protocol through all phases of surgery was outlined (Figure 1). Factors associated with POD 1 discharge include BMI less than 30 and shorter operative time (Table 1). No major complications occurred in the POD1 group. Conclusion: POD1 discharge following DIEP flap breast reconstruction is safe for select patients. Lower BMI and shorter operative times may be predictive in identifying patients as candidates for earlier discharge.

Table 1. POD1 Discharge versus non-POD1 Discharge

	POD1 Discharge (N=23)	POD2+ Discharge (N=487)	p-value
Age	49.6	50.8	0.543
BMI	27.78	30.3	0.039
Operative Time (mins)	273.7	402.2	<.0001
Hematoma	0	27	<.0001
Total Flap Loss	0	4	0.045
Arterial Thrombosis	0	0	NS
Venous Congestion	0	14	0.0002
Previous Radiation	11	244	0.836
Previous Chemotherapy	8	225	0.283

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