96. Who is a Candidate for Outpatient Microvascular Autologous Reconstruction? A Consecutive Prospective Series

PURPOSE: The extensive nature of perforator-based reconstruction and the need for postoperative flap monitoring has traditionally led to long hospitalizations following breast reconstruction with DIEP flaps. Recently, our institution has developed a protocol optimizing pre-, intra-, and post-operative factors to facilitate discharge following DIEP surgery on an outpatient basis. METHODS: This was a prospective study of series of patients undergoing DIEP surgery performed at a single institution. Beginning April 1, 2024, all patients underwent the same protocol with the goal of discharge to home within 24 hours of surgery. Patient demographics and comorbidities, as well as operative details were collected for each patient. Patients who did not successfully complete the outpatient protocol were compared to those that were using Fischer’s exact tests and student t-tests as appropriate. RESULTS: A total of 16 patients were included in the study. Of those, 10 were successfully discharged on an outpatient basis. There were no statistically significant differences between the groups in terms of demographics or comorbidities. There were no instances of flap loss or takeback for flap concerns, and there were statistically significant differences between groups in terms of post-operative outcomes. Patients who were discharged as an outpatient were more likely to have unilateral surgery (8 vs. 2, P=0.118). CONCLUSION: Outpatient DIEP surgery can be successfully performed on a routine basis. Factors such as unilateral surgery and shorter OR time may make it more likely that a patient may be discharged within 24 hours. Potentially complicating factors hindering same-day discharge can be divided into 3 categories that may be independently evaluated and optimized in future studies include: 1) patient expectations, 2) post-operative complications related to surgery necessitating longer stay or return to operating room, and 3) newly developed comorbidities not directly related to the flap.