Effect of ERAS on Length of Hospital Stay after Microsurgical Breast Reconstruction 1Donald
Rebecca C.
1 Suydam,
BA, Neil
and Barbara Zucker School of Medicine at Hofstra/Northwell Surgery, Northwell Health
Background The Enhanced Recovery after Surgery (ERAS) Society produces evidence-based perioperative care guidelines to achieve early recovery for surgical patients.1 ERAS protocol for breast reconstruction includes preadmission patient education and preoperative lifestyle changes for certain patients. Prophylaxis against venous thromboembolism and microbial infection is shown to have a positive effect on patient outcomes. Postoperatively, focus is put on maintaining adequate fluid and electrolyte balances, providing opioid-sparing pain management, feeding within 24 hours of surgery, monitoring the viability of the flap frequently in the first 72 hours, and mobilization of the patient 2 within 24 hours of surgery.
2 Tanna,
2Division
MD
of Plastic and Reconstructive
Methods
Conclusions
Data was collected from DIEP Flap Breast Reconstructions completed by Dr. Neil Tanna between 2016 and 2019. Information regarding the procedure, patient demographics, date of service, and length of hospital stay was obtained from AEHR and stored in 3,4 REDCap. The ERAS protocol was initiated at Northwell in 2018. The pre-ERAS cohort consists of the surgeries completed in 2016 and 2017. The ERAS cohort consists of the surgeries completed in 2018 and 2019. The demographics and length of stay for each cohort were compared using a T-Test.
The mean length of hospital stay was statistically significantly longer for patients who underwent surgery before the ERAS protocol was initiated compared to those who underwent surgery with the ERAS protocol (U= 3717.5, p=0.000). Table 2 presents the results from a linear regression model predicting length of hospital stay in days. Receiving surgery with the ERAS protocol is associated with a 1.05 day decrease in the length of hospital stay (p=0.000). The model was significant (F=13.48, p=0.000), accounting for 27.4 percent of the 2 variance (adjusted R ).
Hypothesis Implementation of the ERAS protocol will decrease the length of hospital stay for women undergoing Deep Inferior Epigastric Perforator (DIEP) Flap Breast Reconstruction.
Resources Page.” ERAS Society, 2016, erassociety.org/. 2 Temple-Oberle, Claire M.D., M.Sc.; Shea-Budgell, Melissa A. M.Sc.; Tan, Mark M.D.; Semple, John L. M.D., M.Sc.; Schrag, Christiaan M.D.; Barreto, Marcio M.D.; Blondeel, Phillip M.D., Ph.D.; Hamming, Jeremy M.D.; Dayan, Joseph M.D.; Ljungqvist, Olle M.D., Ph.D.; for the ERAS Society. 3PA Harris, R Taylor, R Thielke, J Payne, N Gonzalez, JG. Conde, Research electronic data capture (REDCap) – A metadata-driven methodology and workflow process for providing translational research informatics support, J Biomed Inform. 2009 Apr;42(2):377-81. 4PA Harris, R Taylor, BL Minor, V Elliott, M Fernandez, L O’Neal, L McLeod, G Delacqua, F Delacqua, J Kirby, SN Duda, REDCap Consortium, The REDCap consortium: Building an international community of software partners, J Biomed Inform. 2019 May 9 [doi: 10.1016/j.jbi.2019.103208]
Results Table 2. Linear regression model predicting length of hospital stay in days.
1“Home
Future Direction ERAS protocol reduces the length of hospital stay in microsurgical breast reconstruction, but future studies should focus on the long-term benefits of ERAS, including patient-reported outcomes. Table 1. Comparison of means between pre-ERAS and ERAS groups