A little over a year ago I learned about ERAS protocol as it pertains to breast reconstruction from the plastic surgeon who performed my DIEP flap. ERAS, Enhanced Recovery after Surgery, protocol was not in place at the time I had breast reconstruction in December of 2014. I wrote a blog about our conversation and what I learned.
I have been reading several social media posts about ERAS and the benefits to patients. One study shared recently on Twitter states in the conclusion of the study:
Conclusion: Enhanced recovery pathway program implementation should be considered as the standard approach for perioperative care in autologous tissue-based breast reconstruction because it does not affect morbidity and is associated with accelerated recovery with reduced postoperative opiate use and decreased length of hospital stay, leading to downstream health care cost savings. ~ Journal of the American Society of Plastic Surgeons
ERAS Protocol Benefits Observed
I find great value in evidence-based studies in my work as a patient advocate. However, nothing beats a first-hand observation of results and benefits from a study you have read. I was recently on travel doing advocacy work for DiepCFoundation. I was able to visit three patients who had DIEP flap breast reconstruction the week I visited them. I saw the patients on a Friday morning. Two patients had their surgery on Tuesday and were waiting on orders to be released from hospital. The third woman, who had her surgery on Wednesday, was walking the halls and met me with a smile. She would be released the following day.
My experience without ERAS vs. Their experience with ERAS
| My Experience without ERAS | Their experience: 3 Patients I observed using ERAS |
|
| Carbohydrate drink the night before and day of surgery to help with the effects of anesthesia and recovery |
| Foley catheter in place from Monday -Friday | Foley catheter removed 1 – 2 days after surgery |
| No solid food for 48 hours | Solid food the day after surgery |
| Walking within 48 hours but with IV and Foley catheter in place! ARGH! | Walking within 24 hours with IV and Foley catheter removed at that point. |
| Minimal post-operative pain | Minimal post-operative pain |
| Opioids first 48 hours (self-regulated pain pump) then switched to oral pain medication. This caused a slower recovery and slowdown of my system. I was groggy and slept a lot while in recovery. | Celebrex (anti-inflammatory); Gabapentin (nerve pain); Tylenol for pain. These ladies were walking the halls and visiting each other in their rooms! |
| Hospital stay: 5 nights | Hospital stay: 2-3 nights |
I am so happy for these three ladies. I talked to other women that weekend who had DIEP flap surgery around the same time or even before I did. When I told them about these gals, their eyes were wide open and they were in disbelief. If I had not seen it for myself I wouldn’t believe the benefits of implementing the ERAS protocol for DIEP flap surgery. A picture speaks a thousand words. Thank you to Barbara, Michelle, and Donna for this wonderful experience and for sharing some gentle hugs while visiting San Antonio and Methodist Hospital where they all had their DIEP flap procedure. Their plastic surgeons were Dr. Oscar Ochoa, Dr. Minas Chrysopoulo, and Dr. Steven Pisano. Three different surgeons, three different patients who all gained the same benefits of the ERAS protocol practiced at PRMA in San Antonio.
It is Worth the Ask: ERAS Protocol Breast Reconstruction
In conclusion, when you have your consult with your plastic surgeon to discuss the process and recovery time for your breast reconstruction, ask the question, “Do you use the ERAS protocol at the facility I will be having my surgery at?” Whether they do or they don’t, it’s worth the ask! Did your surgical group utilize ERAS protocol for your breast reconstruction? I’d love to hear back from you.
