title: Enhanced recovery after surgery in microvascular breast reconstruction.
abstract: BACKGROUND
  Enhanced recovery after surgery (ERAS) pathways have been shown in multiple surgical specialties to decrease hospital length of stay (LOS) after surgery, but they have not been described for patients undergoing microvascular breast reconstruction.
  
  
  METHODS
  A standardized ERAS pathway was developed through multidisciplinary collaboration which addressed all phases of surgical care for patients undergoing free-flap breast reconstruction using an abdominal donor site. Two surgeons used the ERAS pathway, and results were compared with a historical cohort of the same 2 surgeons' patients treated by traditional care after surgery (TRAS). All patients underwent surgery between September 2010 and September 2013. The primary outcome measure was hospital LOS.
  
  
  RESULTS
  A total of 100 patients were analyzed: 49 in the ERAS cohort, and 51 in the TRAS cohort, with a total of 181 flaps. Mean hospital LOS was shorter with ERAS than TRAS (3.9 vs 5.5 days; P<0.001). Total inpatient postoperative opioid usage for the first 3 days, in oral morphine equivalents, was less for ERAS than TRAS (167.3 vs 574.3 mg; P<0.001), a decrease of 71%, with similar pain scores for the 2 groups. Overall 30-day major complication rates were not significantly different between the groups (P=0.21).
  
  
  CONCLUSIONS
  The initiation of an ERAS pathway significantly decreased hospital LOS in our study. The pathway also significantly decreased the amount of opioids used postoperatively by 71%, without a consequent increase in patient-reported pain.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Niles J
authors.initials: NJ
authors.lastname: Batdorf
authors.affiliation: Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Valerie
authors.initials: V
authors.lastname: Lemaine
authors.affiliation: Pharmacy Services, Mayo Clinic, Rochester, MN, USA.
authors.forename: Jenna K
authors.initials: JK
authors.lastname: Lovely
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA.
authors.forename: Karla V
authors.initials: KV
authors.lastname: Ballman
authors.affiliation: Pharmacy Services, Mayo Clinic, Rochester, MN, USA.
authors.forename: Whitney J
authors.initials: WJ
authors.lastname: Goede
authors.affiliation: Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Jorys
authors.initials: J
authors.lastname: Martinez-Jorge
authors.affiliation: Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Andria L
authors.initials: AL
authors.lastname: Booth-Kowalczyk
authors.affiliation: Department of Nursing, Mayo Clinic, Rochester, MN, USA.
authors.forename: Pamela L
authors.initials: PL
authors.lastname: Grubbs
authors.affiliation: Department of Nursing, Mayo Clinic, Rochester, MN, USA.
authors.forename: Lisa D
authors.initials: LD
authors.lastname: Bungum
authors.affiliation: Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA. Electronic address: saintcyr.michel@mayo.edu.
authors.forename: Michel
authors.initials: M
authors.lastname: Saint-Cyr
mesh_terms: D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D016462:Mammaplasty / Q000379:methods*; D008866:Microsurgery; D008875:Middle Aged; D059408:Pain Management; D010147:Pain Measurement; D011183:Postoperative Complications; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology*
keywords: Autologous breast reconstruction; DIEP flap; ERAS; Enhanced recovery after surgery; Microsurgery