Enhanced recovery after surgery (ERAS) protocol reduces perioperative narcotic requirement and length of stay in patients undergoing mastectomy with implant-based reconstruction

Abstract Introduction Enhanced Recovery after Surgery (ERAS) protocols have contributed to shortened hospital stays and reduced narcotic use after common surgical procedures. Though ERAS protocols exist for breast surgery, they have not been studied for implant-based reconstruction after mastectomy. Methods Twenty-three consecutive patients undergoing mastectomy with implant-based reconstruction were treated with perioperative gabapentin, acetaminophen, and NSAIDs. Data regarding clinical course and medication requirement were compared to a historical control cohort (n=23) receiving usual care after mastectomy. Opioid analgesics were converted to oral morphine equivalents (OMEs) for comparison between groups. Results Patients treated with the ERAS protocol required significantly fewer narcotics as measured in OMEs over postoperative days 0-2. Patient reported pain scores were equivalent between groups, as were postoperative complication rates of nausea, hematoma, and infection. Additionally, ERAS patients had significantly shorter mean length of hospital stay (1.3 vs. 2.5 days, p = 0.037). Conclusions Patients receiving perioperative gabapentin, acetaminophen, and NSAIDs under an ERAS protocol required significantly fewer narcotics and shorter length of stay. This protocol may merit consideration for use at other centers.