by Haddock, Nicholas T.; Garza, Ricardo; Boyle, Carolyn E.;
Liu, Yulun; Teotia, Sumeet S.
Plastic and Reconstructive Surgery: November 2021
- Volume 148 - Issue 5 - p 948-957
Background:
Enhanced recovery after surgery (ERAS) includes multiple
interventions that have yielded positive outcomes in a number of surgical
fields. The authors evaluated whether an ERAS protocol and the subsequent addition
of liposomal bupivacaine affect patient outcomes specifically in deep inferior
epigastric perforator (DIEP) flap breast reconstruction.
Methods:
All patients treated with DIEP flaps from January of 2016 to
December of 2019 were reviewed retrospectively. The ERAS protocol was
implemented midway through 2017; halfway through 2018, intraoperative
transversus abdominis plane blocks with liposomal bupivacaine were added to the
protocol. Such interventions allowed for comparison of three patient groups: before
ERAS, during ERAS, and after ERAS plus liposomal bupivacaine. Primary outcomes
observed were postoperative opioid consumption and length of stay. The p values
were obtained using the Wilcoxon test for pairwise comparisons.
Results:
After adjusting for ERAS group compliance, 216 patients were
analyzed. The pre-ERAS group was composed of 67 patients, the ERAS group was
composed of 69 patients, and the ERAS plus liposomal bupivacaine group was
composed of 80 patients. Postoperative opioid consumption was reduced when
comparing the pre-ERAS and ERAS groups (from 275.7 oral morphine equivalents to
146.7 oral morphine equivalents; p < 0.0001), and also reduced with the
addition of liposomal bupivacaine (115.3 oral morphine equivalents; p = 0.016).
Furthermore, hospital length of stay was decreased from 3.6 days in the
pre-ERAS group to 3.2 days (p = 0.0029) in the ERAS group, and to 2.6 days (p
< 0.0001) in the ERAS group plus liposomal bupivacaine groups.
Conclusions:
Enhanced recovery after surgery protocols decrease
postoperative opioid consumption and hospital length of stay in DIEP flap
breast reconstruction. The addition of liposomal bupivacaine further
strengthens the impact of the protocol. CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
