ENHANCED RECOVERY PROTOCOL FOLLOWING AUTOLOGOUS FREE TISSUE BREAST RECONSTRUCTION

Enhanced recovery after surgery (ERAS) aims to achieve earlier recovery, reduced hospital length of stay (LOS) and improved outcomes. Following the introduction of our ERAS protocol, we sought to review our ERAS experience. Our aims were to evaluate the LOS, post-operative complications, discharge analgesia, patient satisfaction and our ERAS protocol compared to the literature.

This was a retrospective review of all our prospectively managed database between January 2016 and December 2016. Patient demographics, LOS, discharge analgesia and complications were collected. Patient satisfaction was determined using a 10-point Likert scale questionnaire.

A total of 70 patients underwent breast reconstruction using free deep inferior epigastric artery (DIEP) flaps. The mean age at surgery was 51 years (range 23-71). The mean LOS was 4.89 days (range 4-10). 61 patients (87%) were discharged within 5 days. 65 patients (93%) were discharged home on no controlled opioids. Major and minor complications were encountered in 3 patients (4%) and 5 (7%) patients respectively. There were no cases of complete or partial flap failure. 30-day patient satisfaction was high (>9/10) across all domains but patients complained of nausea & vomiting.

The adoption of our enhanced recovery protocol for autologous breast reconstruction has resulted in a mean LOS and opioid use reduction similar to contemporary literature. However, we have seen that there are further refinements that can be made to our ERAS protocol and there is still a need to develop a stronger evidence base to support our practices. This is in parallel with ongoing education and audit cycles to foster a culture of ERAS that can safely optimise patient outcomes.