Gregory T Kennedy1, Christine M Hill1, Ye Huang1, Alycia So1, Joshua Fosnot2, Liza Wu2, John T Farrar3, Julia Tchou4. 1. Departments of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 2. Plastic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 3. Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 4. Departments of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: Julia.tchou@pennmedicine.upenn.edu.
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.
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.
Authors: Ehsan Jazini; Alexandra E Thomson; Andre D Sabet; Omar Sohail; Leah Y Carreon; Lindsay Orosz; Fenil R Bhatt; Rita Roy; Colin M Haines; Thomas C Schuler; Christopher R Good Journal: Spine Deform Date: 2021-11-06
Authors: Kate R Pawloski; Regina Matar; Varadan Sevilimedu; Audree B Tadros; Laurie J Kirstein; Hiram S Cody; Kimberly J Van Zee; Monica Morrow; Tracy-Ann Moo Journal: Ann Surg Oncol Date: 2021-07-10 Impact factor: 5.344