Deep Inferior Artery Perforator Flap-Enhanced Recovery After Surgery: Perspectives From Australia's Only Public...

Area of Science:

• Plastic Surgery
• Surgical Oncology
• Perioperative Medicine

Background:

• Enhanced Recovery After Surgery (ERAS) pathways are increasingly adopted in autologous breast reconstruction (ABR) to optimize patient recovery.
• This study evaluates a newly standardized electronic ERAS pathway implemented in 2023-2024 against a prior transitional cohort (2017-2018).

Purpose of the Study:

• To assess the impact of a standardized electronic ERAS pathway on patient outcomes following DIEP flap breast reconstruction.
• To compare length of stay, opioid consumption, and complication rates between the standardized ERAS pathway and a transitional ERAS cohort.

Main Methods:

• A perioperative ERAS protocol was applied to patients undergoing DIEP flap reconstruction.
• Key protocol elements included patient education, standardized surgical proformas, fluid management, opioid reduction, early mobilization, and diet reintroduction.
• Outcomes were compared between the 2023-2024 standardized ERAS cohort (n=54) and the 2017-2018 transitional ERAS cohort (n=48).

Main Results:

• The standardized ERAS pathway significantly reduced the average length of stay from 5.8 to 4.5 days (p=0.007).
• Total oral morphine-equivalent daily dosage (oMEDD) decreased from 155.0 mg to 111.6 mg (p=0.011).
• Patient-controlled analgesia (PCA) duration was reduced from 31.8 hours to 14.2 hours (p=0.010), with no change in incidence.

Conclusions:

• The standardized ERAS pathway for DIEP flap reconstruction effectively reduced length of stay and PCA duration.
• No significant increase in major or minor complication rates was observed, indicating a safe and effective protocol.
• The findings highlight the benefits of multidisciplinary collaboration and provide a framework for best practices in Australian ABR.