101. Factors Influencing Reduced Postoperative Hospital Stay in DIEP Flap Breast Reconstruction

PURPOSE: Autologous breast reconstruction with deep inferior epigastric perforator (DIEP) flaps is practiced in multiple centers across the US and the world and has been a powerful adjunct to autologous breast reconstruction in women diagnosed with breast cancer. Historically, a criticism of autologous breast reconstruction is lengthy postoperative hospital stay. However, the factors that may impact post-operative length of stay (LOS) have yet to be examined in the literature. This study aims to evaluate perioperative factors that may contribute to an earlier discharge in patients undergoing DIEP flap breast reconstruction. METHODS: A retrospective review was conducted at a single center evaluating 107 patients who underwent DIEP flap breast reconstructions by a single surgeon between October 2021 to July 2024. Patients were analyzed for their demographic data, operative time, ischemia time, along with length of stay, post-anesthesia care unit (PACU) time, post-operative opioid usage, operative time, and complication, reoperation, and failure rate. RESULTS: This study reviewed 107 female patients (49.2 ± 3.8 years of age) that underwent either bilateral (n=156) and unilateral (n=31) DIEP flap breast reconstruction. The average BMI was 29.72 ± 2.4. 10 patients were discharged on POD1 (9%), while 84 patients were discharged on POD2+ of which 65 were discharged on POD2 (61%), and 19 were discharged on POD3 (18%). Overall operative time was significantly lower in the POD1 cohort compared with the POD2+ cohort (428 versus 460 minutes, p=0.021). The fascial incision length was lower in POD1 group compared with the POD2+ cohort (9.8 ± 1.3 vs 11.9 ± 0.8 centimeters, p=0.01). The average LOS was lower in cases with the use of abdominal drains compared to those with zero abdominal drains (2.69 vs 2.04 days, p=0.013). Average morphine equivalents (p=0.018) and time in PACU (p=0.012) differed significantly between patients staying two or more days and patients staying less than two days. The average postoperative LOS for bilateral DIEP flaps decreased, averaging 3.3 days in 2022 to 1.8 days in 2024 (p = 0.01). Wound dehiscence was most frequent (n=14, 9%), followed by surgical site infection (n=10, 7%), seroma (n=9, 6%), skin necrosis (n=5, 3%), and hematoma (n=2,1%). There were 2 cases of flap loss. No major complications occurred in POD1 group. Overall, the average follow-up was 302 ± 12 days. CONCLUSIONS: In summary, POD1 discharge after delayed DIEP flap reconstruction is safe in select patients and a powerful tool in our reconstructive armamentarium. We found a significant trend towards a shorter total length of stay between 2022 and 2024. Factors such as shorter fascial incision, shorter operative time, fewer drains, and earlier patient mobilization may be predictive of lower postoperative opioid requirements and earlier hospital discharge.