How low can we go: Achieving postoperative day 1 discharge after deep inferior epigastric perforator, a safe and feasible goal.

[BACKGROUND] Although rare reports describe discharge to be possible within 48 hours for patients undergoing autologous breast reconstruction, average length of stay remains around 3 days. This study aimed to demonstrate that patients can be safely discharged within 1 day after deep inferior epigastric perforator (DIEP) flap breast reconstruction.

[METHODS] A retrospective review was performed of patients who underwent free flap breast reconstruction by a single surgeon from November 2021 to May 2024. Demographics, operative details, opioid ingestion, length of stay, and postoperative complications were reviewed to assess safety of discharge in 24 hours.

[RESULTS] One hundred sixty-four DIEP flaps were performed on 119 patients. Average length of stay was 1.5 days (SD 0.7 days), with 67 (56.3%) patients discharged on postoperative day 1 (POD1) and 52 (43.7%) discharged after POD1. Of those discharged on POD1, 13 (19.4%) went home in <24 hours. Comparing patients discharged on POD1 to those discharged after POD1, there were statistically significant differences in reconstruction laterality (76.1% vs 44.2% unilateral, p<0.001), operative time (341.0 vs 439.1 minutes, p<0.001), and opioid ingestion on POD1 (4.2 IV morphine milligram equivalents [MME] vs 11.3 MME, p<0.001). Common complications included abdominal wound dehiscence (10.1%), abdominal seroma (5.0%), breast wound dehiscence (4.9%), and breast mastectomy flap necrosis (3.0%). Seventy-six (63.9%) patients had no complications. Overall success rate of flap reconstruction was 100%.

[CONCLUSION] Collaboration among surgery, anesthesia, and dedicated nursing teams allow 23-hour observation or outpatient DIEP reconstruction to be safe and feasible. By attaining equivalency with implant-based reconstruction, access to flap reconstruction can be extended to more patients.