Enhanced Recovery After Surgery Pathways for Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Systematic Review and Meta-analysis

Deep inferior epigastric perforator (DIEP) surgery is one of the most difficult breast reconstruction techniques available, both in terms of operating complexity and patient recovery. Enhanced recovery after surgery (ERAS) pathways were recently introduced in numerous subspecialties to reduce recovery time, patient pain, and cost by providing multi-modal perioperative care. Plastic surgery has yet to widely integrate ERAS with DIEP reconstruction, mostly due to insufficient data on patient outcomes with this combined approach. Five major medical databases were queried using predetermined search criteria according to the PRISMA statement. Statistical analysis was performed using Cochrane’s RevMan (v5.4). 466 articles were identified. 14 studies were included in the review with a combined sample of 2102 patients. Eight studies were included in the meta-analysis with a combined sample of 1679 patients. On average, the included studies utilized 11.69 of 18 suggested protocols for ERAS with breast reconstruction. Our primary outcome, length of stay, was reduced by a mean 1.12 (95% CI [-1.30,-0.94], n=1,627, p