Impact of ERAS in breast reconstruction with a latissimus dorsi flap, compared to conventional management

G Taba; V Ceccato; O Fernandes; S Michel; L Darrigues; N Girard; E Gauroy; L Pauly; T Gaillard; F Reyal; J Hotton

doi:10.1016/j.bjps.2023.06.073

Impact of ERAS in breast reconstruction with a latissimus dorsi flap, compared to conventional management

J Plast Reconstr Aesthet Surg. 2023 Oct:85:202-209. doi: 10.1016/j.bjps.2023.06.073. Epub 2023 Jul 4.

Authors

G Taba¹, V Ceccato¹, O Fernandes², S Michel¹, L Darrigues¹, N Girard¹, E Gauroy¹, L Pauly¹, T Gaillard¹, F Reyal¹, J Hotton³

Affiliations

¹ Department of Surgical Oncology, Institut Godinot, Rue du Général Koenig, 51100 Reims, France.
² Department of Anesthesia, Institut Godinot, Rue du Général Koenig, 51100 Reims, France.
³ Department of Surgical Oncology, Institut Godinot, Rue du Général Koenig, 51100 Reims, France. Electronic address: judicael.hotton@reims.unicancer.fr.

PMID: 37524032
DOI: 10.1016/j.bjps.2023.06.073

Abstract

Background: Enhanced recovery after surgery (ERAS) programs are associated with improved management, reduced hospital stays, and lower complication rates.

Objective: To evaluate the impact of ERAS on mean length of stay (LOS) and postoperative morbidity in breast reconstruction with latissimus dorsi flap (LDF) compared with conventional recovery program.

Patients and method: All patients operated by LDF between December 2014 and October 2020: those managed before April 2018, when the ERAS protocol was introduced, were included in the "no ERAS" group, and beyond in the "ERAS" group.

Results: Out of 193 patients, 129 were included in the "ERAS" group and 64 in the "no ERAS" group. There was a significant difference between the two groups in LOS (4.2 ± 1.5 days in the "ERAS" group vs. 5.4 ± 1.9 days in the "no ERAS" group; p < 0.001), high-grade complications at 30 days (9.3% in the "ERAS" group vs. 25% in the "no ERAS" group; p = 0.01), reintervention rate (13.9% vs. 26.6%, respectively; p = 0.02), and 30-day rehospitalization rate (6.2% in the "ERAS" group vs. 15.6% in the "no ERAS" group; p = 0.03).

Conclusion: The ERAS protocol has a positive impact on breast reconstruction with LDF without generating additional adverse effects. These results support the democratization of these programs for breast reconstruction surgery.

Keywords: Breast cancer; Breast reconstruction; Enhanced recovery after surgery; Latissimus dorsi flap.

MeSH terms

Enhanced Recovery After Surgery*
Humans
Length of Stay
Mammaplasty* / methods
Postoperative Complications / etiology
Retrospective Studies
Superficial Back Muscles* / transplantation
Surgical Flaps