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Do Patient Expectations of Discharge Affect Length of Stay After Deep Inferior Epigastric Perforator Flap for Breast Reconstruction?
Ravinder Bamba, MD1, Jordan Wiebe, DO1, Christopher Ingersol, MD1, Steven Dawson, BA 1, Mithun Sinha, PhD1, Adam C. Cohen, MD2, Brett Hartman, DO1, Mary E. Lester, MD1, Aladdin H. Hassanein, MD, MMSc1
1Division of Plastic Surgery
Indiana University School of Medicine
Indianapolis, IN
2Department of Surgery
Community Health Network
Indianapolis, IN
Indiana University
2021-01-28
Presenter: Ravi Bamba
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. The program director is responsible for making a statement within the confines of the box below specific to how much of the work on this project represents the original work of the resident. All authors/submitters of each abstract should discuss this with their respective program director for accurate submission of information as well as the program director's approval for inclusion of his/her electronic signature.
Director Name: William Wooden
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Introduction
Deep Inferior Epigastric Artery Perforator (DIEP) flap is a common method of breast reconstruction. The effect of patient expectations on length of stay (LOS) after DIEP has not been evaluated. The purpose of this study was to investigate whether patient expectations affect LOS.
Methods
A retrospective chart review was performed for patients undergoing DIEP flaps for breast reconstruction from 2017-2020. Patients were divided in Group I (early expectations) and Group II (standard expectations). Group I patients had expectations set for discharge postoperative day (POD) 2 for unilateral DIEP and POD 3 for bilateral DIEP. Group II patients were given expectations for POD 3-4 for unilateral DIEP and POD 4-5 for bilateral.
Results
The study included 215 DIEP flaps (45 unilateral and 85 bilateral). Group I (early expectations) included 56 patients (24 unilateral DIEPs, 32 bilateral). Group II (standard expectations) had 74 patients (21 unilateral, 53 bilateral). LOS for unilateral DIEP was 2.9 days for Group I compared to 3.7 days for Group II (p=0.004). Group I bilateral DIEP patients had LOS of 3.5 days compared to 3.9 days for Group II (p=0.02). Immediate timing of DIEP (Group I 42.9% versus Group II 52.7%) and body mass index (BMI) (Group I 32.1 versus group II 30.8) were similar (p=0.25).
Conclusion
Our study found significantly shorter hospital stay after DIEP flap for patients who expected an earlier discharge date. Patient expectations should be considered during patient counseling and as a confounding variable when analyzing ERAS protocol studies.
