Postoperative Free Flap Breast Protocol Optimizing Resources and Patient Safety
| Autor: | Michele A. Manahan, Tobias J. Bos, Brian H. Cho, Benjamin T. Ostrander, Hannah M. Carl, Allison Haley, Darya Fadavi, Franca Kraenzlin, Gedge D. Rosson, Nima Khavanin, Justin M. Sacks, Deepa Bhat |
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| Rok vydání: | 2020 |
| Předmět: |
Graft Rejection
Reoperation medicine.medical_specialty Mammaplasty Free flap 030230 surgery law.invention 03 medical and health sciences Patient safety 0302 clinical medicine law DIEP flap Cost Savings Medicine Humans Medical history Retrospective Studies business.industry Length of Stay Middle Aged Intensive care unit Epigastric Arteries Patient Discharge Surgery 030220 oncology & carcinogenesis Female Patient Safety business Complication Breast reconstruction Body mass index Perforator Flap |
| Zdroj: | Journal of reconstructive microsurgery. 36(5) |
| ISSN: | 1098-8947 |
| Popis: | Background As deep inferior epigastric artery perforator (DIEP) flaps have gained popularity in breast reconstruction, the postoperative care of these patients, including the appropriate hospital length-of-stay and the need for intensive care unit (ICU) admission, has become a topic of debate. At our institution, we have adopted a pathway that aims for discharge on postoperative day 3, utilizing continuous tissue oximetry without ICU admission. This study aims to evaluate outcomes with this pathway to assess its safety and feasibility in clinical practice. Methods A retrospective review was performed of patients undergoing DIEP flap breast reconstruction between January 2013 and August 2014. Data of interest included patient demographics and medical history as well as complication rates and date of hospital discharge. Results In total, 153 patients were identified undergoing 239 DIEP flaps. The mean age was 50 years (standard deviation [SD] = 10.2) and body mass index (BMI) 29.4 kg/m2 (SD = 5.2). Over the study period, the flap failure rate was 1.3% and reoperation rate 3.9%. Seventy-one percent of patients were discharged on postoperative day 3. Nine patients required hospitalization beyond 5 days. Theoretical cost savings from avoiding ICU admissions were $1,053 per patient. Conclusion A pathway aiming for hospital discharge on postoperative day 3 without ICU admission following DIEP flap breast reconstruction can be feasibly implemented with an acceptable reoperation and flap failure rate. |
| Databáze: | OpenAIRE |
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