Use of Enhanced Recovery After Surgery (ERAS) Protocol for Immediate Sub-Muscular Breast Reconstruction after Outpatient Mastectomy is Safe and Significantly Reduces Costs

Authors

Ryan Kunkel
Audrey Rich
Venus Barlas
Stephanie Fine

Document Type

Poster

Publication Date

3-6-2020

Abstract

Introduction:

• ERAS protocols are associated with decreased postoperative stays, reduced opioid use, lower rates of postoperative nausea and vomiting, and lower overall costs to institutions and healthcare systems
• The aim of this study was to evaluate the impact of an ERAS approach on mastectomy with implant-based subpectoral reconstruction (IBR) with respect to procedure cost and 30-day complication rates for both ambulatory surgery patients and patients hospitalized overnight

Methods:

Study Type: Retrospective chart review analysis

Subjects: Patients over age 18 undergoing nipple-sparing mastectomy or skinsparing mastectomy with subpectoral IBR at a single institution.

Study Cohorts:

● ERAS: same-day surgery at an ambulatory surgical center

● Overnight hospital admission control group

● Surgeries performed by 2 breast surgeons and 3 plastic surgeons

Analysis Plan:

● ERAS compared to control group, divided by surgical modality (nipple sparing vs. non-nipple sparing mastectomy)

● Demographics, comorbidities, 30-day complications, and cost analyses were examined.

● Direct costs were defined as patient-specific costs, such as pharmacy costs, and radiology charges. Indirect costs included a facility-derived multiplier added to the encounter to cover fixed expenses such as salaried labor, and building overhead.

Conclusions:

● There were no significant differences in 30-day complication rates between patients whose mastectomy with reconstruction procedure was at an ambulatory surgical center (utilizing our ERAS protocol) and patients whose operation was at a hospital facility with a planned overnight admission.

● Social factors were the main determinant for identifying those patients who could be safely discharged from an ambulatory setting from those requiring a planned admission.

● On average, a 30% cost saving can be expected with the application of ERAS principles and a same-day surgery approach.

Comments

Presented at the University of New Mexico Health Science 2020 Annual Quality Improvement and Patient Safety Symposium

Recommended Citation

Kunkel, Ryan; Audrey Rich; Venus Barlas; and Stephanie Fine. "Use of Enhanced Recovery After Surgery (ERAS) Protocol for Immediate Sub-Muscular Breast Reconstruction after Outpatient Mastectomy is Safe and Significantly Reduces Costs." (2020). https://digitalrepository.unm.edu/hsc_qips/43