title: Introducing the fast track surgery principles can reduce length of stay after autologous breast reconstruction using free flaps: A case control study.
abstract: BACKGROUND
  The concept of fast-track surgery (FTS) is a peri- and postoperative care concept developed to reduce length of hospital stay (LOS) and morbidity after surgery. FTS programmes have been reported from other surgical specialities, but there are few reports of FTS in plastic surgery.
  
  
  METHODS
  Autologous breast reconstructions have been performed with abdominal free flaps since 1994. In 2006, an FTS program was introduced. Important changes in procedure were: early mobilisation, fewer/faster removal of drains and urinary catheter, discontinuation of epidural analgesia, planned early discharge, and multimodal opioid-sparing analgesia. The results from all unilateral, breast reconstructions in the first 5 years after the implementation of the FTS (n = 177) were compared to results prior to the FTS (n = 292). Flap type, operating time, blood loss and ischaemic time, LOS, early flap related and systemic complications (< 30 days) were analysed.
  
  
  RESULTS
  FTS significantly reduced mean LOS from 7.4 days to 6.2 days (p = 0.0002). When compared to pre-FTS results, similar flap types, operating time, blood loss and ischaemic time were found. LOS > 7 days were due to complications, the most common being haematoma. Prevalence of complications (6.5 vs 7.9%) and flap loss (2 vs 2%) did not increase. Haematomas seemed more frequent with the use of NSAID than with COX-2 inhibitors (9 vs 4%); however, the difference was not statistically significant.
  
  
  CONCLUSIONS
  By introducing a simple, peri- and postoperative care concept it is possible to reduce LOS after microsurgery by at least 1 day without an increase in complications or flap loss.
authors.affiliation: a 1 Department of Plastic Surgery, Breast Surgery and Burns, Section 2102.
authors.forename: Christian
authors.initials: C
authors.lastname: Bonde
authors.affiliation: a 1 Department of Plastic Surgery, Breast Surgery and Burns, Section 2102.
authors.forename: Hoda
authors.initials: H
authors.lastname: Khorasani
authors.affiliation: b 2 Department of Anaesthesiology.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Eriksen
authors.affiliation: a 1 Department of Plastic Surgery, Breast Surgery and Burns, Section 2102.
authors.forename: Mette
authors.initials: M
authors.lastname: Wolthers
authors.affiliation: c 3 Section of Surgical Pathophysiology, Rigshospitalet, Copenhagen University Hospital , Copenhagen, Denmark, Europe.
authors.forename: Henrik
authors.initials: H
authors.lastname: Kehlet
authors.affiliation: a 1 Department of Plastic Surgery, Breast Surgery and Burns, Section 2102.
authors.forename: Jens
authors.initials: J
authors.lastname: Elberg
mesh_terms: D000009:Abdominal Muscles / Q000637:transplantation*; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D019074:Epigastric Arteries / Q000601:surgery / Q000637:transplantation*; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply* / Q000637:transplantation; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D061646:Operative Time; D019990:Perioperative Care / Q000379:methods; D011182:Postoperative Care / Q000379:methods; D011379:Prognosis; D012016:Reference Values; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014182:Transplantation, Autologous; D016896:Treatment Outcome
keywords: Breast reconstruction; microvascular; plastic surgery