Postoperative Free Flap Breast Protocol Optimizing Resources and Patient Safety

Area of Science:

• Plastic Surgery
• Breast Reconstruction
• Microsurgery

Background:

• Deep inferior epigastric artery perforator (DIEP) flaps are increasingly utilized for breast reconstruction.
• Postoperative care, including hospital length-of-stay and ICU admission, requires optimization for DIEP flap patients.
• Continuous tissue oximetry is employed in a novel pathway to guide postoperative management.

Purpose of the Study:

• To evaluate the safety and feasibility of a clinical pathway for DIEP flap breast reconstruction.
• To assess outcomes associated with a pathway aiming for discharge on postoperative day 3.
• To determine the effectiveness of avoiding intensive care unit (ICU) admission in DIEP flap patients.

Main Methods:

• Retrospective review of patients undergoing DIEP flap breast reconstruction from January 2013 to August 2014.
• Collection of data on patient demographics, medical history, complication rates, and hospital discharge dates.
• Analysis of outcomes based on a pathway utilizing continuous tissue oximetry without ICU admission.

Main Results:

• The study included 153 patients and 239 DIEP flaps, with a mean age of 50 years and BMI of 29.4 kg/m².
• Flap failure rate was 1.3% and reoperation rate was 3.9%.
• Seventy-one percent of patients were discharged on postoperative day 3, with significant theoretical cost savings from avoiding ICU admissions.

Conclusions:

• A pathway targeting hospital discharge on postoperative day 3 without ICU admission is feasible for DIEP flap breast reconstruction.
• This pathway demonstrates acceptable flap failure and reoperation rates.
• The implemented pathway supports efficient and safe postoperative care for DIEP flap patients.