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Enhanced Recovery Pathways for Flap-Based Reconstruction: Systematic Review and Meta-Analysis
Yan Yu Tan1,2, Frank Liaw3, Robert Warner4
1Blizard Institute, Barts and The London School of Medicine and Dentistry, Centre for Cutaneous Research, 4 Newark Street, London, E1 2AT, UK. yanyu@doctors.org.uk.
Aesthetic Plastic Surgery
|April 6, 2021
Summary
Enhanced Recovery After Surgery (ERAS) pathways reduce hospital stay for autologous flap reconstructions without increasing complications. These ERAS protocols can be tailored to institutional needs, with potential for broader application.
Area of Science:
- Surgical innovation and patient recovery protocols.
- Evidence-based medicine and systematic review methodology.
Background:
- Enhanced Recovery After Surgery (ERAS) pathways are increasingly recognized for improving surgical patient outcomes.
- Growing interest exists in applying ERAS principles to reconstructive surgery, particularly autologous flap procedures.
Purpose of the Study:
- To systematically review and summarize the existing literature on ERAS pathways for autologous flap-based reconstructions.
- To identify key components and evaluate the outcomes associated with ERAS in this surgical context.
Main Methods:
- A comprehensive literature search was conducted across multiple databases (e.g., Cochrane, MEDLINE, EMBASE) and trial registries.
- Included studies focused on ERAS pathways for free and pedicled autologous flap reconstructions, published in English.
- Primary outcome was length of stay; secondary outcomes included various complication rates.
Main Results:
- Sixteen studies met the inclusion criteria, covering breast and head/neck reconstructions.
- ERAS pathways were associated with a reduced length of stay (mean reduction of 1.57 days) compared to control groups.
- No significant differences were observed in flap loss, reoperation, readmission, or infection rates between ERAS and control groups; compliance reporting was limited.
Conclusions:
- ERAS pathways effectively reduce length of stay in flap-based reconstructions without compromising patient safety or increasing complication rates.
- Individualized adaptation of ERAS pathways to institutional resources and patient populations is recommended.
- Further development and application of ERAS pathways for other reconstructive areas (e.g., chest wall, perineum, lower limb) show promise.
