Enhanced Recovery After Surgery in Immediate DIEP Flap Breast Reconstruction: Reducing Length of Stay and Opioid Use

Background: To improve patient outcomes amid reduced healthcare resources during the COVID-19 pandemic, a single Canadian cancer center implemented an Enhanced Recovery After Surgery (ERAS) protocol for autologous DIEP flap breast reconstruction. Methods: This retrospective cohort study included 100 consecutive patients undergoing microsurgical breast reconstruction with DIEP flaps using the ERAS protocol and 100 patients using a standard protocol. Primary outcomes were the hospital length of stay and opioid use. Secondary outcomes included postoperative complications, laxative and antiemetic consumption. Results: In this study, 80% of the patients had immediate reconstruction, while the remaining patients received either delayed immediate or delayed reconstruction. Patients in the ERAS group had shorter hospital stays (2.8 vs 4.5 days; P < 0.001) and lower total opioid use (50.2 vs 136.3 mg; P < 0.001). This reduction was also observed when breaking down opiates per day of hospitalization (30.2 vs 18.2 mg; P < 0.001), and in the first 24 postoperatively hours (35.7 vs 67.6 mg; P < 0.001). The control group had a higher incidence of postoperative complications, including seroma, partial and total flap necrosis, compared to the ERAS group. However, readmission rates were similar between the two groups. Conclusion: Implementing the ERAS protocol for DIEP flap breast reconstruction can significantly reduce hospital length of stay and postoperative opioid requirements without increasing the risk of adverse events. This pattern holds true for immediate reconstructions with DIEP flaps.