Moving Toward the Outpatient DIEP Flap: Factors Influencing Early Discharge.

[BACKGROUND] Enhanced recovery after surgery (ERAS) protocols can reduce the length of stay (LOS) for surgical patients, including those undergoing unilateral deep inferior epigastric artery perforator (DIEP) flap breast reconstruction, allowing most patients to be discharged by postoperative day 2. However, some patients require a prolonged inpatient stay because of difficulty completing postoperative milestones. This study aims to identify factors associated with increased LOS after DIEP flap breast reconstruction and to assess safety of earlier discharge.

[METHODS] A retrospective review was performed of all patients who underwent unilateral DIEP flap reconstruction between January of 2021 and December of 2022 at Memorial Sloan Kettering Cancer Center. The authors assessed patient characteristics, comorbidities, and complications to identify correlations with LOS and milestone completion after implementation of an ERAS protocol.

[RESULTS] A total of 278 patients were included; the median LOS was 2.25 days (interquartile range, 2.19 to 2.33 days). Factors associated with delayed discharge included increased age, increased operative time, history of diabetes, and history of immunologic disease. Increased operative time was the only variable associated with prolonged milestone completion. A subanalysis of the safety of an earlier discharge goal of postoperative day 1 when compared with a goal of postoperative day 2 demonstrated no significant differences in complication rates.

[CONCLUSIONS] Discharge timing and milestone completion after unilateral DIEP flap reconstruction is variable and dependent on patient and operative characteristics. These insights can aid in patient optimization and may suggest ERAS protocol adjustments to enable earlier discharge for more patients. Furthermore, earlier discharge goals appear safe for appropriate patients.

[CLINICAL QUESTION/LEVEL OF EVIDENCE] Risk, III.