Breaking Tradition: The Feasibility and Outcomes of Postoperative Day 1 Discharge After Microsurgical Breast Reconstruction".

[BACKGROUND] Microsurgical breast reconstruction has traditionally required extended postoperative hospitalization for flap monitoring and patient recovery. We conducted this study to identify factors associated with early discharge and assess whether early discharge increases the risk of unplanned hospital-based acute care.

[METHODS] We analyzed an institutional microsurgical database to identify consecutive women who underwent microvascular breast reconstruction between May 2020 and January 2025. Patients were stratified into early discharge (<=24 hours) and standard discharge (>24 hours) groups. Primary outcomes included hospital length of stay and incidence of unplanned hospital-based acute care within 30 days. Multivariable logistic regression was used to identify factors associated with early discharge and unplanned hospital-based acute care.

[RESULTS] A total of 170 patients underwent 332 microsurgical flaps, most commonly deep inferior epigastric artery perforator (DIEP) flaps (94.0%). The mean patient age was 50 years, body mass index (BMI) was 29, and 64.1% had an American Society of Anesthesiologists (ASA) classification of II. The mean hospital stay was 2 days, with 25.3% discharged early. Early discharge patients were significantly less likely to require transfusion during the index hospitalization (OR=0.16, 95% CI=0.04-0.61). Twenty-eight unplanned hospital-based acute care encounters occurred in 22 patients (12.9%), primarily for pain, dehydration, hematoma, or infection. Early discharge was not associated with increased odds of unplanned hospital-based acute care (OR=1.63, 95% CI=0.45-5.90).

[CONCLUSIONS] Early discharge following microsurgical breast reconstruction did not show increased risk of flap loss or post-discharge complications. When guided by Enhanced Recovery After Surgery (ERAS) protocols, early discharge can be achieved without increasing the risk of unplanned hospital-based care.