Kristen Jogerst1, Olivia Thomas2, Heidi E Kosiorek3, Richard Gray4, Patricia Cronin4, William Casey5, Alanna Rebecca5, Ryan Craner6, Tonia Young-Fadok7, Barbara Pockaj4. 1. Department of Surgery, Division of Surgical Oncology and Endocrine Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA. jogerst.kristen@mayo.edu. 2. Mayo Clinic School of Medicine, Phoenix, AZ, USA. 3. Department of Research-Biostatistics, Mayo Clinic Arizona, Phoenix, AZ, USA. 4. Department of Surgery, Division of Surgical Oncology and Endocrine Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA. 5. Department of Surgery, Division of Plastic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA. 6. Department of Anesthesiology, Mayo Clinic Arizona, Phoenix, AZ, USA. 7. Department of Surgery, Division of Colorectal Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA.
Abstract
BACKGROUND: Enhanced recovery after surgery (ERAS®) principles have been beneficial in major abdominal surgery. ERAS® was instituted in our breast surgery practice in 2017. The goal of this study was to evaluate the feasibility of outpatient mastectomies before and after ERAS®. METHODS: A retrospective review of all mastectomies between 1/2013 and 6/2018 was performed. Patients receiving autologous flap reconstruction were excluded. The institution-specific ERAS® pathway began on February 1, 2017. Patient characteristics, operative intervention, and postoperative outcomes were compared between pre-ERAS® and post-ERAS® groups and between outpatient and inpatient subgroups. Continuous and categorical variables were compared using Wilcoxon rank-sum and Chi-square analyses. RESULTS: A total of 487 patients were analyzed. Three hundred and forty-seven (71%) were prior to ERAS® and 140 after (29%). The two groups were not significantly different in background characteristics. Same-day discharge occurred in 58.6% of post-ERAS® patients versus 7.2% of pre-ERAS® patients (p < 0.001). Liposomal bupivacaine block was used for pain control more in the post-ERAS® group, 62.1% versus 6.1% (p < 0.001). Reconstruction type differed with 45.7% of the post-ERAS® group undergoing direct-to-implant reconstruction versus 34.3% of pre-ERAS® patients (p < 0.001) and with higher rates of submuscular implant and tissue expander placement in the pre-ERAS® versus post-ERAS® group (p < 0.001). Complications rates were lower in the post-ERAS® group versus pre-ERAS® group, 32.9% versus 52.4% (p < 0.001). The outpatient subgroup had higher rates of liposomal bupivacaine administration 74.4% versus 44.8% (p < 0.001). Baseline characteristics and complication rates did not differ between outpatient and admitted subgroups. CONCLUSION: ERAS® principles can be applied to breast cancer patients and allow for outpatient mastectomies with no increase in postoperative morbidity.
BACKGROUND: Enhanced recovery after surgery (ERAS®) principles have been beneficial in major abdominal surgery. ERAS® was instituted in our breast surgery practice in 2017. The goal of this study was to evaluate the feasibility of outpatient mastectomies before and after ERAS®. METHODS: A retrospective review of all mastectomies between 1/2013 and 6/2018 was performed. Patients receiving autologous flap reconstruction were excluded. The institution-specific ERAS® pathway began on February 1, 2017. Patient characteristics, operative intervention, and postoperative outcomes were compared between pre-ERAS® and post-ERAS® groups and between outpatient and inpatient subgroups. Continuous and categorical variables were compared using Wilcoxon rank-sum and Chi-square analyses. RESULTS: A total of 487 patients were analyzed. Three hundred and forty-seven (71%) were prior to ERAS® and 140 after (29%). The two groups were not significantly different in background characteristics. Same-day discharge occurred in 58.6% of post-ERAS® patients versus 7.2% of pre-ERAS® patients (p < 0.001). Liposomal bupivacaine block was used for pain control more in the post-ERAS® group, 62.1% versus 6.1% (p < 0.001). Reconstruction type differed with 45.7% of the post-ERAS® group undergoing direct-to-implant reconstruction versus 34.3% of pre-ERAS® patients (p < 0.001) and with higher rates of submuscular implant and tissue expander placement in the pre-ERAS® versus post-ERAS® group (p < 0.001). Complications rates were lower in the post-ERAS® group versus pre-ERAS® group, 32.9% versus 52.4% (p < 0.001). The outpatient subgroup had higher rates of liposomal bupivacaine administration 74.4% versus 44.8% (p < 0.001). Baseline characteristics and complication rates did not differ between outpatient and admitted subgroups. CONCLUSION: ERAS® principles can be applied to breast cancerpatients and allow for outpatient mastectomies with no increase in postoperative morbidity.
Authors: Sami M Abujbarah; Kristen Jogerst; Heidi E Kosiorek; Sarwat Ahmad; Patricia A Cronin; William Casey; Ryan Craner; Alanna Rebecca; Barbara A Pockaj Journal: Ann Surg Oncol Date: 2022-07-18 Impact factor: 4.339
Authors: Michelle C Specht; Bridget N Kelly; Eleanor Tomczyk; Olivia A Ford; Alexandra J Webster; Barbara L Smith; Michelle A Gadd; Amy S Colwell; Eric C Liao Journal: Ann Surg Oncol Date: 2022-05-11 Impact factor: 4.339
Authors: Sarah N Chiang; Michael J Finnan; Gary B Skolnick; Justin M Sacks; Joani M Christensen Journal: J Surg Oncol Date: 2022-04-07 Impact factor: 2.885