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Aesthetic Plastic Surgery

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01-10-2021 | Care | Review

Enhanced Recovery Pathways for Flap-Based Reconstruction: Systematic Review and Meta-Analysis

Authors: Yan Yu Tan, Frank Liaw, Robert Warner, Simon Myers, Ali Ghanem

Published in: Aesthetic Plastic Surgery | Issue 5/2021

Abstract

Background

Enhanced Recovery After Surgery (ERAS) pathways are known to improve patient outcomes after surgery. In recent years, there have been growing interest in ERAS for reconstructive surgery.

Objectives

To systematically review and summarise literature on the key components and outcomes of ERAS pathways for autologous flap-based reconstruction.

Data Sources

Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Current Controlled Trials, World Health Organization International Clinical Trials Registry Platform and reference lists of relevant studies.

Inclusion Criteria

All primary studies of ERAS pathways for free and pedicled flap-based reconstructions reported in the English language.

Outcome Measures

The primary outcome measure was length of stay. Secondary outcomes were complication rates including total flap loss, partial flap loss, unplanned reoperation within 30 days, readmission to hospital within 30 days, surgical site infections and medical complications.

Results

Sixteen studies were included. Eleven studies describe ERAS pathways for autologous breast reconstructions and five for autologous head and neck reconstructions. Length of stay was lower in ERAS groups compared to control groups (mean reduction, 1.57 days; 95% CI, − 2.15 to − 0.99). Total flap loss, partial flap loss, unplanned reoperations, readmissions, surgical site infections and medical complication rates were similar between both groups. Compliance rates were poorly reported.

Conclusion

ERAS pathways for flap-based reconstruction reduce length of stay without increasing complication rates. ERAS pathways should be adapted to each institution according to their needs, resources and caseload. There is potential for the development of ERAS pathways for chest wall, perineum and lower limb reconstruction.

Level of Evidence III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Available only for authorised users

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Title: Enhanced Recovery Pathways for Flap-Based Reconstruction: Systematic Review and Meta-Analysis
Authors: Yan Yu Tan
Frank Liaw
Robert Warner
Simon Myers
Ali Ghanem
Publication date: 01-10-2021
Publisher: Springer US
Keyword: Care
Published in: Aesthetic Plastic Surgery / Issue 5/2021
Print ISSN: 0364-216X
Electronic ISSN: 1432-5241
DOI: https://doi.org/10.1007/s00266-021-02233-3

At a glance: The STEP trials

Springer Medicine

Enhanced Recovery Pathways for Flap-Based Reconstruction: Systematic Review and Meta-Analysis

Abstract

Background

Objectives

Data Sources

Inclusion Criteria

Outcome Measures

Results

Conclusion

Level of Evidence III

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Objectives

Data Sources

Inclusion Criteria

Outcome Measures

Results

Conclusion

Level of Evidence III

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