Abstract:
BACKGROUND:Enhanced recovery after surgery (ERAS) protocols have known benefits in the inpatient setting, but little is known about their impact in the subsequent outpatient setting. On discharge, multimodal analgesia has been discontinued, nerve blocks and pain pumps have worn off, and patients enter a substantially different physical environment, potentially resulting in a rebound effect. The objective of this study was to investigate the effect of ERAS protocol implementation on outpatient opioid use and recovery. METHODS:Patients who underwent abdominally based microsurgical breast reconstruction before and after ERAS implementation were reviewed retrospectively. Ohio state law mandates that no more than 7 days of opioids may be prescribed at a time, with the details of all prescriptions recorded in a statewide reporting system, from which opioid use was determined. RESULTS:A total of 105 patients met inclusion criteria, of which 46 (44 percent) were in the pre-ERAS group and 59 (56 percent) were in the ERAS group. Total outpatient morphine milligram equivalents used in the ERAS group were less than in the pre-ERAS group (337.5 morphine milligram equivalents versus 668.8 morphine milligram equivalents, respectively; p =0.016). This difference was specifically significant at postoperative week 1 (p =0.044), with gradual convergence over subsequent weeks. Although opioid use was significantly less in the ERAS group, pain scores in the ERAS group were comparable to those in the pre-ERAS group. CONCLUSIONS:The benefits of ERAS protocols appear to extend into the outpatient setting, further supporting their use to facilitate recovery, and highlighting their potential role in helping to address the prescription opioid abuse problem. CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, III.
journal_name
Plast Reconstr Surgjournal_title
Plastic and reconstructive surgeryauthors
Rendon JL,Hodson T,Skoracki RJ,Humeidan M,Chao AHdoi
10.1097/PRS.0000000000006546subject
Has Abstractpub_date
2020-03-01 00:00:00pages
645-651issue
3eissn
0032-1052issn
1529-4242pii
00006534-202003000-00012journal_volume
145pub_type
杂志文章abstract::A case is reported in which a closed compression capsulotomy for fibrous capsular contracture was followed by rupture of the implant bag with the immediate appearance of silicone gel in the axilla. A possible mechanism, analogous to that of high-pressure injection injuries of the hands, is hypothesized. ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-197812000-00013
更新日期:1978-12-01 00:00:00
abstract:BACKGROUND:Although the use of the hyaluronic acid with cohesive polydensified matrix hyaluronic acid has been well explored in subjects with lighter skin (i.e., Fitzpatrick skin types I, II, and III), further exploration in subjects with Fitzpatrick skin types IV, V, and IV is warranted. The primary purpose of the stu...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/PRS.0b013e318299ff53
更新日期:2013-10-01 00:00:00
abstract::We report a major modification of technique for the transverse abdominal island flap, namely, taking the anterior rectus fascia with the muscle. We believe that this protects the fine vascular network supplying the flap. This has resulted in a more reliable flap, confirmed by increased fluorescein uptake, and signific...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-198311000-00031
更新日期:1983-11-01 00:00:00
abstract::From 1979 to 1995 in our clinic, vascularized bone grafting was performed in 29 patients with large bone defects, established nonunion, congenital pseudoarthrosis, or avascular necrosis in the upper extremity. Four patients had traumatic bone defects, six had posttraumatic nonunions, two had congenital pseudoarthroses...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199803000-00022
更新日期:1998-03-01 00:00:00
abstract:BACKGROUND:The authors conducted a review of the recent literature on the monitoring of free flaps to create an overview of the current monitoring devices and their potential as an ideal monitoring method. METHODS:A literature-based study was conducted using the PubMed and Cochrane databases. The following search term...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章,评审
doi:10.1097/PRS.0b013e3181c49580
更新日期:2010-01-01 00:00:00
abstract:BACKGROUND:Vertical scar reduction mammaplasty has the advantage of reduced scar burden and improved long-term projection of the breasts. The technique has been criticized for being restricted to cases of mild to moderate mammary hypertrophy and is considered more intuitive and difficult to learn when compared with mor...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/01.prs.0000218173.16272.6c
更新日期:2006-06-01 00:00:00
abstract:BACKGROUND:Extensive spinal neoplasms are difficult to manage. Following resection, arthrodesis of the spine can be performed with instrumentation, but this often fails in the setting of radiation therapy. Use of the free fibula flap for anterior spinal fusion to correct deformities has been described in multiple studi...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0b013e31820cf4a6
更新日期:2011-05-01 00:00:00
abstract:BACKGROUND:Since 2005, seven facial composite tissue allotransplantations have been performed in five different centers in three countries. Four teams have reported their outcomes in separate publications. The authors sought to review the first four global experiences and compare several factors. This review facilitate...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章,评审
doi:10.1097/PRS.0b013e3181c722a8
更新日期:2010-02-01 00:00:00
abstract::The hypothesis that incomplete resorption of osteons in an autogenous cortical bone graft may limit its replacement by new bone regeneration was explored by implanting a hydroxyapatite replica of a coral skeletal structure into bone gaps. This implant contained channels and interconnections similar to those in osteon-...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-197905000-00004
更新日期:1979-05-01 00:00:00
abstract::Split-thickness nail bed grafting is the accepted method of treatment for injuries involving loss of nail bed tissue. The nail bed of the great toe may be used without donor-site morbidity, and nail bed grafting may be combined with other procedures for fingertip reconstruction. A case of fingertip avulsion injury wit...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-198803000-00023
更新日期:1988-03-01 00:00:00
abstract::The purpose of this study was to compare the sensitivity of a 20-mHz ultrasonic Doppler device to detect microvascular thrombosis placed on the vein with that placed on the artery. A feasibility study in animals preceded a comparative clinical study in patients. Six rabbits were used to develop a bilateral hind limb p...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199401000-00024
更新日期:1994-01-01 00:00:00
abstract::Appropriate deepening of the nasofrontal junction remains one of the most difficult parts of rhinoplasty. A guarded burr is introduced that provides a safe and effective means of deepening or creating a shallow nasofrontal groove. The burr has a special guard that prevents the cutting of soft tissue. The guarded burr ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-198909000-00023
更新日期:1989-09-01 00:00:00
abstract:BACKGROUND:The authors evaluated the use of national databases to track surgical complications among abdominoplasty and breast augmentation patients. METHODS:Their study population included all patients with abdominoplasty or breast augmentation in the Tracking Operations and Outcomes for Plastic Surgeons (TOPS) and C...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0b013e3181bf8378
更新日期:2009-12-01 00:00:00
abstract::The authors present their latest development of a strictly vertical retroauricular incision to minimize a sequela of a face lift, namely, a visible scar. The temporal preauricular vertical incision and the retroauricular vertical incision form two parallel arms of a U-shaped incision. Anteriorly, a downward rotation f...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-200206000-00058
更新日期:2002-06-01 00:00:00
abstract::Auricular pseudocyst is an asymptomatic cystic swelling of the upper portion of the auricle. Various therapeutic approaches have been employed with variable success. We report our results with nine patients treated by needle aspiration and bolstered pressure sutures applied over both aspects of the cyst for 1 week. Tr...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199104000-00030
更新日期:1991-04-01 00:00:00
abstract::The purpose of this study was to gain information which might be helpful in understanding the influence of palate surgery on abnormal maxillary growth. The finding of actin-rich cells in the granulation tissue of palatal wounds supports the hypothesis that one of the functions of those cells is contraction--and the la...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-197809000-00015
更新日期:1978-09-01 00:00:00
abstract:BACKGROUND:Conventional palatoplasty relies on extensive mucosal incisions and isolation of flaps on the palatine vessels to facilitate midline closure and velar reconstruction. This introduces substantial scarring, which has adverse effects on vascularity and growth. The authors have developed a minimally invasive pal...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0000000000000280
更新日期:2014-07-01 00:00:00
abstract::Deformities of the adjacent facial bones are common with large vascular tumors. Most hemangiomas will resolve spontaneously, but the incidence of resolution appears to be quite low when the adjacent bones are affected. In these, we have used high dosage corticosteroid therapy in the early cases, particularly those inv...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-197903000-00003
更新日期:1979-03-01 00:00:00
abstract::Recently, there have been many new designs in both the surface texture and chemical composition of breast implants that claim reduced constrictive capsular formation. The purpose of this study was to utilize a quantitative method to determine the firmness of capsules formed around saline-filled smooth silicone, textur...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199405000-00002
更新日期:1994-05-01 00:00:00
abstract::Since the 1970s, anecdotal reports have described a relatively small number of women who received silicone gel breast implants and later developed either a recognized rheumatologic disease or unexplained symptoms suggestive of an autoimmune disorder. The study reported here examined whether there is any association be...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:
更新日期:1995-12-01 00:00:00
abstract::The V-Y advancement myotarsocutaneous flap was used to avoid excessive scarring during reconstruction of a full-thickness upper eyelid defect following surgical excision of a malignant tumor. This method has a number of advantages: It has a short operative time, it is a one-stage procedure, it does not require lining ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199709001-00025
更新日期:1997-09-01 00:00:00
abstract::One of the critical parameters that has not been examined carefully following laser skin resurfacing is the effect of eschar on the wound healing process. Because occlusive dressings minimize the occurrence of eschar, the present study was undertaken to evaluate the effect of occlusion following laser resurfacing. It ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-200005000-00044
更新日期:2000-05-01 00:00:00
abstract:BACKGROUND:Attempted separation of craniopagus twins has continued to be associated with devastating results since the first partially successful separation with one surviving twin in 1952. To understand the factors that contribute to successful separation in the modern era of neuroimaging and modern surgical technique...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章,评审
doi:10.1097/PRS.0000000000002269
更新日期:2016-07-01 00:00:00
abstract:BACKGROUND:The nasolabial flap is a pedicled flap with a wide description and application for use in lateral nasal wall, ala, columella, and intraoral reconstruction. It is a versatile flap that is well tolerated by the patient, with very acceptable donor-site scars. The soft and spongy nature of the flap, with its pro...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0b013e318182370b
更新日期:2008-09-01 00:00:00
abstract::We review 97 cases of SMCP, 79 of which were operated. The comparative results are presented. For those requiring surgery (i.e. those having hypernasality), it has been our experience that the use of a pharyngeal flap, alone or combined with a palatoplasty, is productive of better speech results than is a palatoplasty...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-197607000-00010
更新日期:1976-07-01 00:00:00
abstract::Breast reconstructions performed with latissimus dorsi and transverse rectus abdominis myocutaneous (TRAM) flaps in 82 patients with a history of previous chest-wall irradiation were compared with similar reconstructions in 202 nonirradiated patients to determine whether prior irradiation was associated with more freq...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:
更新日期:1994-03-01 00:00:00
abstract:BACKGROUND:The loss of the blink reflex and the ability to close the eye actively are disabling functional and aesthetic impairments common to patients with facial paralysis. Nonphysiologic (static) management techniques involve implantation of devices in the upper eyelid that mechanically aid eye closure. The most pop...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/01.prs.0000299919.18076.b4
更新日期:2008-03-01 00:00:00
abstract:BACKGROUND:Molecular mechanisms that direct the extent of the foreign body reaction to implanted biological meshes and their subsequent incorporation are poorly understood. The purpose of this study was to compare the influence of non-cross-linked human dermis (AlloDerm) with that of cross-linked porcine dermis (Permac...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0b013e3182818a3d
更新日期:2013-04-01 00:00:00
abstract:BACKGROUND:Most lesions of the upper extremity are common and benign, and many have questioned the need for routine pathologic evaluation of these specimens. The authors aim to examine the national use of routine pathologic examination of nonmalignant hand lesions to help guide health care policy and practice patterns....
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0000000000004592
更新日期:2018-08-01 00:00:00
abstract::The incidence of free-flap failure is reported at 4 to 5 percent. Often, these failures are attributed to postoperative venous thrombosis with salvage rates reported at 42 percent. The use of thrombolytics has been effective in laboratory protocols; however, there have been only case reports to substantiate their use ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199811000-00021
更新日期:1998-11-01 00:00:00