Implementing Our Microsurgical Breast Reconstruction Enhanced Recovery after Surgery Pathway: Consensus Obstacles and Recommendations

Jill P. Stone, MD, FRCSC; Charalampos Siotos, MD; Samuel Sarmiento, MD, MPH, MBA; Claire Temple-Oberle, MD, MSc, FRCSC; Oluseyi Aliu, MD; Damon S. Cooney, MD, PhD; Kristen P. Broderick, MD; Justin M. Sacks, MD, MBA; Michele A. Manahan, MD; Gedge D. Rosson, MD

doi:10.1097/GOX.0000000000001855

Plastic and Reconstructive Surgery, Global Open (Jan 2019)

Implementing Our Microsurgical Breast Reconstruction Enhanced Recovery after Surgery Pathway: Consensus Obstacles and Recommendations

Jill P. Stone, MD, FRCSC,
Charalampos Siotos, MD,
Samuel Sarmiento, MD, MPH, MBA,
Claire Temple-Oberle, MD, MSc, FRCSC,
Oluseyi Aliu, MD,
Damon S. Cooney, MD, PhD,
Kristen P. Broderick, MD,
Justin M. Sacks, MD, MBA,
Michele A. Manahan, MD,
Gedge D. Rosson, MD

Affiliations

Jill P. Stone, MD, FRCSC: From the *Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Md.
Charalampos Siotos, MD: From the *Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Md.
Samuel Sarmiento, MD, MPH, MBA: From the *Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Md.
Claire Temple-Oberle, MD, MSc, FRCSC: †Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
Oluseyi Aliu, MD: From the *Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Md.
Damon S. Cooney, MD, PhD: From the *Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Md.
Kristen P. Broderick, MD: From the *Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Md.
Justin M. Sacks, MD, MBA: From the *Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Md.
Michele A. Manahan, MD: From the *Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Md.
Gedge D. Rosson, MD: From the *Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Md.

DOI: https://doi.org/10.1097/GOX.0000000000001855
Journal volume & issue: Vol. 7, no. 1
p. e1855

Abstract

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Summary:. Enhanced recovery after surgery pathways are well established in other surgical specialties but are relatively new in plastic surgery. These guidelines focus on improving patient care by incorporating evidence-based recommendations. Length of stay is shorter, and overall hospital costs are lower without compromising patient satisfaction. When care is standardized, ambiguity is removed and physician acceptance is improved. Yet, implementation can be challenging on an institutional level. The Johns Hopkins microsurgical breast reconstruction team identified areas of dogmatic dissonance during 3 focus groups to formalize an enhanced recovery pathway for microsurgical breast reconstruction. Six microsurgeons used nominal group technique to reach consensus. Four discussion points were identified: multidisciplinary buy-in, venous thromboembolism (VTE) chemophylaxis, early feeding, and dietary restrictions. Evidence-based recommendations and our enhanced recovery after surgery protocol are provided.

Published in Plastic and Reconstructive Surgery, Global Open

ISSN: 2169-7574 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://www.prsgo.com

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