Enhanced Recovery After Surgery (ERAS) Protocol Allows Safe Same-day Discharge In Expander Based And Oncoplastic Breast Reconstruction
Ellen F. Niu, BS1, James C. Frageau, BS1, Hunter Rogoff, MD2, Brigette Cannata, BS1, Katherine E. Wang, BA, MBE1, Jocellie Marquez, MD, MBA3, Brittni Munn, PA3, Syed Shah, MD4, Anastasia Bakoulis, DO5, Patricia Farrelly, MD5, Brian O’Hea, MD5, Tara L. Huston, MD, FACS3
1Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, USA, 2 Division of Plastic and Reconstructive Surgery, Geisinger Medical Center, Danville, Pennsylvania, USA, 3Division of Plastic and Reconstructive Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, New York, USA, 4Department of Anesthesia, Stony Brook University Hospital, Stony Brook, New York, USA, 5 Division of Breast Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, New York, USA
PURPOSE:
Data following Enhanced Recovery After Surgery (ERAS) with same-day discharge in breast reconstruction is limited. This study evaluates early postoperative outcomes following same-day discharge in tissue expander-immediate breast reconstruction (TE-IBR) and oncoplastic breast reconstruction (OBR).
METHODS: A single-institution retrospective review of TE-IBR patients from 2017-2022 and OBR patients from 2014-2022. Patients were divided by procedure and recovery pathway: Group 1 (TE-IBR, overnight admission), Group 2 (TE-IBR, ERAS), Group 3 (oncoplastic, overnight admission), and Group 4 (oncoplastic, ERAS). Group 1 and 2 were subdivided by implant location: Group 1a (pre-pectoral) and 1b (sub-pectoral); Group 2a (pre-pectoral) and 2b (sub-pectoral). Demographics, comorbidities, complications, and reoperations were analyzed.
RESULTS: 160 TE-IBR patients (Group 1: 91; Group 2: 69) and 60 OBR patients (Group 3: 8; Group 4: 52) were included. Of the 160 TE-IBR patients, 73 underwent pre-pectoral reconstruction (Group 1a: 25; Group 2a: 48) and 87 underwent sub-pectoral reconstruction (Group 1b: 66; Group 2b: 21). There were no differences in demographics and comorbidities between Groups 1 and 2. Group 3 had a higher average BMI than Group 4 (37.6 vs 32.2, p <0.022). There was no significant difference between Groups 1a and 2a or between Groups 1b and 2b in rates of infection, hematoma, TE loss, or reoperations. Notably, no ERAS patients required hospital admission. Group 3 and Group 4 showed no significant difference in any complications or in reoperations.
CONCLUSION: Our research shows that same-day discharge in both TE-IBR and OBR does not increase risk for major complications or reoperations.
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