Postoperative Free Flap Breast Protocol Optimizing Resources and Patient Safety

Darya Fadavi; Allison Haley; Nima Khavanin; Franca Kraenzlin; Tobias J. Bos; Brian H. Cho; Hannah M. Carl; Deepa Bhat; Benjamin T. Ostrander; Michele A. Manahan; Gedge D. Rosson; Justin M. Sacks

doi:10.1055/s-0040-1701698

Journal of Reconstructive Microsurgery, Inhaltsverzeichnis

J Reconstr Microsurg 2020; 36(05): 379-385
DOI: 10.1055/s-0040-1701698

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Postoperative Free Flap Breast Protocol Optimizing Resources and Patient Safety

Authors

Darya Fadavi‡^*

¹Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
Allison Haley‡^*

¹Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
Nima Khavanin

¹Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
Franca Kraenzlin

¹Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
Tobias J. Bos

¹Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
Brian H. Cho

¹Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
Hannah M. Carl

¹Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
Deepa Bhat

¹Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
Benjamin T. Ostrander

¹Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
Michele A. Manahan

¹Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
Gedge D. Rosson

¹Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
Justin M. Sacks

¹Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland

Abstract

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.

Keywords

deep inferior epigastric perforator flap - breast reconstruction - free flap - tissue oximetry - intensive care unit - length of stay

Volltext

Referenzen

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