Enhanced recovery after surgery pathways for deep inferior epigastric perforator flap breast reconstruction: A systematic review and meta-analysis.

Autor: Pierzchajlo N; Mercer University School of Medicine, Savannah, GA, USA. Electronic address: Noah.Pierzchajlo@live.mercer.edu., Zibitt M; Medical College of Georgia, Augusta, GA, USA., Hinson C; Frederick P. Whiddon College of Medicine, University of South Alabama, Mobile, AL, USA., Stokes JA; Mercer University School of Medicine, Savannah, GA, USA., Neil ZD; Mercer University School of Medicine, Savannah, GA, USA., Pierzchajlo G; Mercer University School of Medicine, Savannah, GA, USA., Gendreau J; Department of Biomedical Engineering, Johns Hopkins, Baltimore, MD, USA., Buchanan PJ; Plastic, Aesthetic, & Hand/Micro Surgeon, The Georgia Institute for Plastic Surgery, Savannah, GA, USA.
Jazyk: angličtina
Zdroj: Journal of plastic, reconstructive & aesthetic surgery : JPRAS [J Plast Reconstr Aesthet Surg] 2023 Dec; Vol. 87, pp. 259-272. Date of Electronic Publication: 2023 Oct 15.
DOI: 10.1016/j.bjps.2023.10.058
Abstrakt: Background: Deep inferior epigastric perforator (DIEP) surgery is one of the most difficult breast reconstruction techniques available, both in terms of operating complexity and patient recovery. Enhanced recovery after surgery (ERAS) pathways were recently introduced in numerous subspecialties to reduce recovery time, patient pain, and cost by providing multimodal perioperative care. Plastic surgery has yet to widely integrate ERAS with DIEP reconstruction, mostly due to insufficient data on patient outcomes with this combined approach.
Methods: Five major medical databases were queried using predetermined search criteria according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. Statistical analysis was performed using Cochrane's RevMan (v5.4).
Results: A total of 466 articles were identified. A total of 14 studies were included in the review with a combined sample of 2102 patients. Eight studies were included in the meta-analysis with a combined sample of 1679 patients. On average, the included studies utilized 11.69 of 18 suggested protocols for ERAS with breast reconstruction. Our primary outcome, length of stay, was reduced by a mean of 1.12 (95% confidence interval [CI] [-1.30, -0.94], n = 1627, p < 0.001) days in the ERAS group. Postoperative oral morphine equivalents (OME) were also reduced in the ERAS group by 104.02 (95% CI [-181.43, -26.61], n = 545, p = 0.008) OME. The ERAS group saw a significant 3.54 (95% CI [-4.43, -2.65], n = 527, p < 0.001) standardized mean difference cost reduction relative to the control groups. The surgery time was reduced by 60.46 (95% CI [-125, 4.29], n = 624, p < 0.07) min, although this was not statistically significant.
Conclusions: The ERAS pathway in DIEP breast reconstruction is consistently associated with reduced hospital stay, opioid use, and patient cost. Moreover, there appears to be no evidence of serious adverse outcomes associated with the application of the ERAS protocol.
Competing Interests: Declaration of Competing Inrerest The authors have no personal or institutional interest with regards to the authorship and/or publication of this manuscript.
(Copyright © 2023 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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