May 2017 #PRSJournalClub: “Is Enhanced Recovery the New Standard of Care in Microsurgical Breast Reconstruction?”

by Raj P. Parikh, MD, MPHS (@rajparikhmd)

The May #PRSJournalClub offered an excellent and comprehensive discussion of a great PRS article entitled “Is Enhanced Recovery the New Standard of Care in Microsurgical Breast Reconstruction?” by Memorial Sloan Kettering Cancer Center’s (@sloan_kettering) Dr. Joseph Dayan (@JosephDayanMD) and Dr. Joe Disa (@disaj3).

In their study, Dayan et al. retrospectively reviewed outcomes following implementation of a multidisciplinary enhanced recovery after surgery (ERAS) protocol for microsurgical breast reconstruction. The authors evaluated and compared outcomes between two cohorts: patients treated in a conventional perioperative protocol between June and December 2013 and patients treated in an ERAS protocol between April and August 2015. In total, 91 patients were analyzed (N = 42 for ERAS pathway; N = 49 for conventional/pre-ERAS pathway) to ascertain if clinically meaningful differences existed in the primary outcomes of mean length of stay (LOS) and total postoperative opioid consumption (in morphine equivalents). The authors demonstrated that utilization of an ERAS protocol, compared to conventional perioperative management, significantly reduced mean LOS (4.0 days versus 5.0 days; p < 0.0001) and total opioid consumption (46.0 mg versus 70.5 mg; p = 0.003) in patients undergoing microsurgical breast reconstruction procedures. Ultimately, these results support the role of ERAS protocols in microsurgical breast reconstruction and this study has incredible relevance to plastic surgeons as our health care environment continues to shift towards emphasizing value-based care.

This outstanding article was discussed in multiple formats for a worldwide audience, providing an in-depth understanding of the article’s salient points and highlighting the value of multi-media and social-media connectivity in our specialty.

A special collection of articles related to this month’s #PRSJournalClub article is available here on the PRS Journal.

PRS Journal Editor-In-Chief Dr. Rohrich (@DrRodRohrich) outlined the advantages of ERAS pathways for microsurgical breast reconstruction in a the following “Hot Topic” video (#PRSHotTopic):

This month’s #PRSJournalClub was also fortunate enough to benefit from a brilliant and detailed analysis of the article from special guest moderator Dr. Donald R. Mackay, William P. Graham III Professor of Plastic Surgery and Chief of the Division of Plastic Surgery at Penn State Hershey Medical Center. Dr. Mackay was joined by Resident Ambassadors to the PRS Editorial Board Jordan Frey, MD (@JordanFreyMD), Shuja Shafqat, MD (@shujashafqatmd), and Chad Purnell, MD (@ChadPurnellMD) on this month’s PRS Journal Club Podcast. Listen to their eloquent review here:


Finally, no #PRSJournalClub would be complete without an animated and memorable live twitter discussion with the authors. Over a two-day period, May 14th-May 15th, article authors Dr. Joseph Dayan (@JosephDayanMD) and Dr. Joe Disa (@disaj3) engaged a worldwide audience, succinctly answering a variety of questions regarding their study and its significance on clinical practice. Plastic surgeons of every level of expertise, from junior residents to professors, and every clinical practice paradigm, from private practice to academic practice, participated and asked insightful questions. This provided for an exciting and meaningful discussion. Don’t worry if you missed it! Highlights of the live twitter discussion are provided below.

Enjoy the recap and please join us for our next #PRSJournalClub!
-Raj

#PRSJournalClub DISCUSSION

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