A. C. Offodile1, C. Gu2, S. Boukovalas1, C. J. Coroneos3, A. Chatterjee4, R. D. Largo1, C. Butler1 1University Of Texas MD Anderson Cancer Center,Department Of Plastic Surgery,Houston, TX, USA 2McGovern Medical School at UTHealth,McGovern Medical School,Houston, TX, USA 3McMaster University,Division Of Plastic Surgery,Hamilton, ONTARIO, Canada 4Tufts Medical Center,Division Of Plastic Surgery,Boston, MA, USA
Introduction: Enhanced recovery after surgery (ERAS) pathways are increasingly promoted in post-mastectomy reconstruction, with several articles reporting their benefits and safety. This meta-analysis appraises the evidence for ERAS pathways in
breast reconstruction.
Methods: Electronic database search identified reports of ERAS protocols in post-mastectomy breast reconstruction. Two reviewers screened studies using predetermined inclusion criteria. Studies evaluated at least one of the following: length of stay (LOS), opioid use, or major complications. Risk of bias was assessed for each study. Meta-analysis was performed to compare outcomes for ERAS versus traditional standard of care. Surgical techniques were assessed through subgroup analysis.
Results: A total of 260 articles were identified; 9 (3.46%) met inclusion criteria with a total of 1191 patients. Autologous flaps comprised the majority of cases. In autologous breast reconstruction, ERAS significantly reduces opioid use (Mean difference (MD) = – 183.96, 95%CI -340.27 – -27.64, p=0.02) and LOS (MD = -1.58, 95%CI -1.99 – -1.18], p<0.00001) versus traditional care. There is no difference in complications (major complications, readmission, hematoma, and infection).
Conclusion: ERAS pathways significantly reduce opioid use and length of hospital stay following autologous breast reconstruction without increasing complication rates. This is salient given the current US healthcare climate of rising expenditures and an opioid crisis.