title: Is Enhanced Recovery the New Standard of Care in Microsurgical Breast Reconstruction?
abstract: BACKGROUND
  At present, there are limited data available regarding the use and feasibility of enhanced recovery pathways for patients undergoing microsurgical breast reconstruction. The authors sought to assess patient outcomes before and after the introduction of an enhanced recovery pathway that was adopted at a single cancer center.
  
  
  METHODS
  A multidisciplinary enhanced recovery pathway was developed for patients undergoing deep inferior epigastric perforator or free transverse rectus abdominis myocutaneous flap breast reconstruction. Core elements of the enhanced recovery pathway included substituting intravenous patient-controlled analgesia with ketorolac and transversus abdominis plane blocks using liposomal bupivacaine, as well as intraoperative goal-directed fluid management. Patients who underwent surgery between April and August of 2015 using the enhanced recovery pathway were compared with a historical control cohort. The primary endpoints were hospital length of stay and total postoperative opioid consumption.
  
  
  RESULTS
  In total, 91 consecutive patients were analyzed (enhanced recovery pathway, n = 42; pre-enhanced recovery pathway, n = 49). Mean hospital length of stay was significantly shorter in the enhanced recovery pathway group than in the pre-enhanced recovery pathway group (4.0 days versus 5.0 days; p < 0.0001). Total postoperative morphine equivalent consumption was also lower in the enhanced recovery pathway group (46.0 mg versus 70.5 mg; p = 0.003). There was no difference in the incidence of 30-day complications between the groups (p = 0.6).
  
  
  CONCLUSIONS
  The adoption of an enhanced recovery pathway for deep inferior epigastric perforator and transverse rectus abdominis myocutaneous flap reconstruction by multiple surgeons significantly decreased opioid consumption and reduced length of stay by 1 day.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: New York, N.Y.|From the Departments of Anesthesiology and Critical Care, Epidemiology and Biostatistics, Plastic and Reconstructive Surgery, and Nursing, Memorial Sloan Kettering Cancer Center.
authors.forename: Anoushka
authors.initials: A
authors.lastname: Afonso
authors.affiliation: New York, N.Y.|From the Departments of Anesthesiology and Critical Care, Epidemiology and Biostatistics, Plastic and Reconstructive Surgery, and Nursing, Memorial Sloan Kettering Cancer Center.
authors.forename: Sabine
authors.initials: S
authors.lastname: Oskar
authors.affiliation: New York, N.Y.|From the Departments of Anesthesiology and Critical Care, Epidemiology and Biostatistics, Plastic and Reconstructive Surgery, and Nursing, Memorial Sloan Kettering Cancer Center.
authors.forename: Kay See
authors.initials: KS
authors.lastname: Tan
authors.affiliation: New York, N.Y.|From the Departments of Anesthesiology and Critical Care, Epidemiology and Biostatistics, Plastic and Reconstructive Surgery, and Nursing, Memorial Sloan Kettering Cancer Center.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Disa
authors.affiliation: New York, N.Y.|From the Departments of Anesthesiology and Critical Care, Epidemiology and Biostatistics, Plastic and Reconstructive Surgery, and Nursing, Memorial Sloan Kettering Cancer Center.
authors.forename: Babak J
authors.initials: BJ
authors.lastname: Mehrara
authors.affiliation: New York, N.Y.|From the Departments of Anesthesiology and Critical Care, Epidemiology and Biostatistics, Plastic and Reconstructive Surgery, and Nursing, Memorial Sloan Kettering Cancer Center.
authors.forename: Jihan
authors.initials: J
authors.lastname: Ceyhan
authors.affiliation: New York, N.Y.|From the Departments of Anesthesiology and Critical Care, Epidemiology and Biostatistics, Plastic and Reconstructive Surgery, and Nursing, Memorial Sloan Kettering Cancer Center.
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Dayan
mesh_terms: D019091:Critical Pathways; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008866:Microsurgery; D008875:Middle Aged; D011182:Postoperative Care / Q000592:standards*; D012189:Retrospective Studies; D059039:Standard of Care; D013524:Surgical Flaps