Enhanced Recovery after Surgery Pathway for Microsurgical Breast Reconstruction: A Systematic Review and Meta-Analysis

Mohamad E. Sebai, Charalampos Siotos, Rachael M. Payne, Jill P. Stone, Stella M. Seal, Mehran Habibi, Kristen Broderick, Justin Michael Sacks, Michele Manahan, Gedge David Rosson

Research output: Contribution to journalArticle

Abstract

Background: The enhanced recovery after surgery pathway was introduced in 1997 as a multimodal approach to reduce preventable postoperative harm and shorten hospital length of stay. However, there is yet no widely accepted enhanced recovery after surgery protocol for microsurgical breast reconstruction. The authors conducted a systematic review and meta-Analysis of the current literature on enhanced recovery after surgery for microsurgical breast reconstruction with regard to postoperative length of stay and morbidity. Methods: The PubMed, Embase, Cochrane, Scopus, and Web of Science databases were searched for all studies published before June of 2016 containing original data on enhanced recovery after surgery in microsurgical breast reconstruction in relation to postoperative length of stay and morbidity. Studies were screened using eligibility criteria. Meta-Analysis, odds ratio, and 95 percent confidence interval were used to pool acquired data. Results: The initial search identified 86 studies. Two independent screeners identified four original articles with a total of 676 patients. Length of stay was significantly shorter for patients on an enhanced recovery after surgery pathway (mean difference,-1.23; 95 percent CI,-1.50 to-0.96; p < 0.001; I 2 = 0 percent; random effects model). Enhanced recovery was not associated with changes in 30-day postoperative morbidity; specifically, no significant difference was observed in rates of partial flap loss (p = 0.44), total flap loss (p = 0.91), breast hematoma (p = 0.69), donor-site infection (p = 0.53), urinary tract infection (p = 0.29), and pneumonia (p = 0.42). Conclusion: The authors' review suggests that enhanced recovery after surgery in microsurgical breast reconstruction is associated with a reduced length of stay, and is not associated with increased postoperative morbidity.

Original languageEnglish (US)
Pages (from-to)655-666
Number of pages12
JournalPlastic and reconstructive surgery
Volume143
Issue number3
DOIs
StatePublished - Mar 1 2019

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Mammaplasty
Meta-Analysis
Length of Stay
Morbidity
PubMed
Urinary Tract Infections
Hematoma
Pneumonia
Breast
Odds Ratio
Tissue Donors
Databases
Confidence Intervals
Infection

ASJC Scopus subject areas

  • Surgery

Cite this

Enhanced Recovery after Surgery Pathway for Microsurgical Breast Reconstruction : A Systematic Review and Meta-Analysis. / Sebai, Mohamad E.; Siotos, Charalampos; Payne, Rachael M.; Stone, Jill P.; Seal, Stella M.; Habibi, Mehran; Broderick, Kristen; Sacks, Justin Michael; Manahan, Michele; Rosson, Gedge David.

In: Plastic and reconstructive surgery, Vol. 143, No. 3, 01.03.2019, p. 655-666.

Research output: Contribution to journalArticle

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T2 - A Systematic Review and Meta-Analysis

AU - Sebai, Mohamad E.

AU - Siotos, Charalampos

AU - Payne, Rachael M.

AU - Stone, Jill P.

AU - Seal, Stella M.

AU - Habibi, Mehran

AU - Broderick, Kristen

AU - Sacks, Justin Michael

AU - Manahan, Michele

AU - Rosson, Gedge David

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N2 - Background: The enhanced recovery after surgery pathway was introduced in 1997 as a multimodal approach to reduce preventable postoperative harm and shorten hospital length of stay. However, there is yet no widely accepted enhanced recovery after surgery protocol for microsurgical breast reconstruction. The authors conducted a systematic review and meta-Analysis of the current literature on enhanced recovery after surgery for microsurgical breast reconstruction with regard to postoperative length of stay and morbidity. Methods: The PubMed, Embase, Cochrane, Scopus, and Web of Science databases were searched for all studies published before June of 2016 containing original data on enhanced recovery after surgery in microsurgical breast reconstruction in relation to postoperative length of stay and morbidity. Studies were screened using eligibility criteria. Meta-Analysis, odds ratio, and 95 percent confidence interval were used to pool acquired data. Results: The initial search identified 86 studies. Two independent screeners identified four original articles with a total of 676 patients. Length of stay was significantly shorter for patients on an enhanced recovery after surgery pathway (mean difference,-1.23; 95 percent CI,-1.50 to-0.96; p < 0.001; I 2 = 0 percent; random effects model). Enhanced recovery was not associated with changes in 30-day postoperative morbidity; specifically, no significant difference was observed in rates of partial flap loss (p = 0.44), total flap loss (p = 0.91), breast hematoma (p = 0.69), donor-site infection (p = 0.53), urinary tract infection (p = 0.29), and pneumonia (p = 0.42). Conclusion: The authors' review suggests that enhanced recovery after surgery in microsurgical breast reconstruction is associated with a reduced length of stay, and is not associated with increased postoperative morbidity.

AB - Background: The enhanced recovery after surgery pathway was introduced in 1997 as a multimodal approach to reduce preventable postoperative harm and shorten hospital length of stay. However, there is yet no widely accepted enhanced recovery after surgery protocol for microsurgical breast reconstruction. The authors conducted a systematic review and meta-Analysis of the current literature on enhanced recovery after surgery for microsurgical breast reconstruction with regard to postoperative length of stay and morbidity. Methods: The PubMed, Embase, Cochrane, Scopus, and Web of Science databases were searched for all studies published before June of 2016 containing original data on enhanced recovery after surgery in microsurgical breast reconstruction in relation to postoperative length of stay and morbidity. Studies were screened using eligibility criteria. Meta-Analysis, odds ratio, and 95 percent confidence interval were used to pool acquired data. Results: The initial search identified 86 studies. Two independent screeners identified four original articles with a total of 676 patients. Length of stay was significantly shorter for patients on an enhanced recovery after surgery pathway (mean difference,-1.23; 95 percent CI,-1.50 to-0.96; p < 0.001; I 2 = 0 percent; random effects model). Enhanced recovery was not associated with changes in 30-day postoperative morbidity; specifically, no significant difference was observed in rates of partial flap loss (p = 0.44), total flap loss (p = 0.91), breast hematoma (p = 0.69), donor-site infection (p = 0.53), urinary tract infection (p = 0.29), and pneumonia (p = 0.42). Conclusion: The authors' review suggests that enhanced recovery after surgery in microsurgical breast reconstruction is associated with a reduced length of stay, and is not associated with increased postoperative morbidity.

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