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

Abstract

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. 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. 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%. 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.