Key result
Implementation of an ERAS pathway in morbidly obese patients undergoing DIEP flap breast reconstruction significantly decreased length of stay (2.06 vs. 3.43 days, p<0.0000001).
Why the study?
Enhanced recovery after surgery pathways are widely used in autologous breast reconstruction, but their benefits in morbidly obese patients have yet to be defined.
Does an Enhanced recovery after surgery (ERAS) pathway improve length of stay, ICU utilization, opioid usage, and cost in morbidly obese patients undergoing DIEP flap breast reconstruction?
Cohort (n=53)
No
Does an Enhanced recovery after surgery (ERAS) pathway improve length of stay, ICU utilization, opioid usage, and cost in morbidly obese patients undergoing DIEP flap breast reconstruction?
Absolute Event Rate: 2.06% vs 3.43%
p-value: p=<0.0000001
ERAS pathways in morbidly obese patients undergoing abdominally based autologous breast reconstruction significantly reduce length of stay, ICU utilization, opioid use, and costs without compromising flap outcomes.
Supports ERAS consideration in morbidly obese DIEP patients; extends general-population benefits but remains hypothesis-generating.
Enhanced recovery after surgery (ERAS) pathways have been widely implemented across many surgical practices, including autologous breast reconstruction. However, the benefits of ERAS in the morbidly obese population have yet to be defined. A retrospective chart review of patients undergoing deep inferior epigastric artery perforator (DIEP) flap breast reconstruction at our institution from 2017 to 2022 was performed. Length of stay (LOS), intensive care unit (ICU) utilization, opioid usage, cost, and flap outcomes were analyzed in patients with body mass index greater than 35 before and after ERAS implementation. Thirty-five morbidly obese patients receiving DIEP flap breast reconstruction were identified before ERAS and 18 after ERAS. There were no differences in unilateral versus bilateral or immediate versus delayed reconstruction. LOS decreased with ERAS (3.43 vs. 2.06 days, p < 0.0000001). ICU utilization decreased with ERAS (0.94 vs. 0.0 days, p < 0.0001). Daily and total opioid usage decreased with ERAS (41.8 vs. 17.9 morphine milligram equivalent [MME], p < 0.0001; 190.5 vs. 54.7 MME, p < 0.0001). Financial metrics improved with ERAS, including decreased total cost ($33,454 vs. $25,079, p = 0.0002) and increased cost margin ($4,458 vs. −$8,306, p = 0.004). There were no differences in donor or recipient site outcomes including flap loss, deep venous thrombosis/pulmonary embolism, hernia/bulge, delayed wound healing, revisions, and blood loss. ERAS pathways maintain benefits in the morbidly obese population undergoing abdominally based autologous breast reconstruction, including decreased LOS, ICU utilization, opioid use, and cost while maintaining successful reconstruction outcomes.
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Stephens et al. (2024) conducted a cohort in Morbid obesity requiring breast reconstruction (n=53). Enhanced recovery after surgery (ERAS) pathway vs. Before ERAS implementation (standard care) was evaluated on Length of stay (LOS) (p=<0.0000001). Implementation of an ERAS pathway in morbidly obese patients undergoing DIEP flap breast reconstruction significantly decreased length of stay (2.06 vs. 3.43 days, p<0.0000001).
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