Enhanced recovery after surgery (ERAS) protocol reduces perioperative narcotic requirement and length of stay in patients undergoing mastectomy with implant-based reconstruction - 15/10/19

Doi : 10.1016/j.amjsurg.2019.10.007

Gregory T. Kennedy ^a, Christine M. Hill ^a, Ye Huang ^a, Alycia So ^a, Joshua Fosnot ^b, Liza Wu ^b, John T. Farrar ^c, Julia Tchou ^a,^⁎
^a Departments of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
^b Plastic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
^c Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

^∗Corresponding author. 3400 Civic Center Boulevard, 10th Floor PCAM South, Philadelphia, PA, 19104, USA.3400 Civic Center Boulevard10th Floor PCAM SouthPhiladelphiaPA19104USA

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Tuesday 15 October 2019

Abstract

Introduction

Enhanced Recovery after Surgery (ERAS) protocols have contributed to shortened hospital stays and reduced narcotic use after common surgical procedures. Though ERAS protocols exist for breast surgery, they have not been studied for implant-based reconstruction after mastectomy.

Methods

Twenty-three consecutive patients undergoing mastectomy with implant-based reconstruction were treated with perioperative gabapentin, acetaminophen, and NSAIDs. Data regarding clinical course and medication requirement were compared to a historical control cohort (n = 23) receiving usual care after mastectomy. Opioid analgesics were converted to oral morphine equivalents (OMEs) for comparison between groups.

Results

Patients treated with the ERAS protocol required significantly fewer narcotics as measured in OMEs over postoperative days 0–2. Patient reported pain scores were equivalent between groups, as were postoperative complication rates of nausea, hematoma, and infection. Additionally, ERAS patients had significantly shorter mean length of hospital stay (1.3 vs. 2.5 days, p = 0.037).

Conclusions

Patients receiving perioperative gabapentin, acetaminophen, and NSAIDs under an ERAS protocol required significantly fewer narcotics and shorter length of stay. This protocol may merit consideration for use at other centers.

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Highlights

•	ERAS protocols have not been studied in implant reconstruction after mastectomy.
•	Gabapentin-based ERAS protocol reduced narcotic requirement after surgery.
•	Pain scores and complication rates were equivalent to the control cohort.
•	ERAS patients had significantly shorter mean length of hospital stay.

Le texte complet de cet article est disponible en PDF.