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Enhanced recovery pathway improved postoperative parameters in breast reconstruction

A novel enhanced recovery pathway intervention was associated with shorter hospital stay and fewer complications in patients undergoing deep inferior epigastric perforator or muscle-sparing free transverse rectus abdominis myocutaneous flap breast reconstruction.

The researchers evaluated patient outcomes before and after a multidisciplinary enhanced recovery pathway had been adopted by a number of surgeons at a cancer center. Components of the intervention included substitution of patient-controlled IV analgesia with other pain management measures along with intraoperative goal-directed fluid management. The study included 49 patients assessed before the enhanced recovery pathway and 42 assessed after.

Patients in the intervention group stayed in the hospital a mean of 4 days, compared with 5 days in the non-intervention group (P < .0001). The enhanced recovery pathway also yielded less morphine equivalent consumption in the postoperative environment, 46.0 mg vs. 70.5 mg (P = .003). However, the incidence of 30-day complications were similar between the two arms of the study. – by Rob Volansky

Disclosure: Afonso reports being on the Health Outcomes Advisory Board at Pacira Pharmaceuticals and receiving an educational grant to help defray travel costs to present at the 2016 Miami Breast Cancer Conference.