Shifting Autologous Breast Reconstruction into an Ambulatory Setting: Patient-Reported Quality of Recovery

Background: As bundled payment models gain popularity, it is imperative that providers use patient outcomes and patient experience to define evidence-based pathways of care. The purpose of this study was to evaluate the quality of recovery experienced by women undergoing early discharge (<24 hours) after autologous breast reconstruction with a pedicled flap and determine predictors of postoperative quality of recovery. Methods: A prospective cohort study was performed on all women undergoing autologous breast reconstruction at Women's College Hospital between September of 2011 and July of 2013 that met study inclusion criteria. The patient-reported Quality of Recovery-27 questionnaire was used to measure quality of recovery on postoperative days 1, 2, 4, and 7. Preoperative and postoperative day 7 Quality of Recovery-27 questionnaire scores were compared. A multivariable random effect model for longitudinal data was used to evaluate any relationship between postoperative Quality of Recovery-27 questionnaire scores and American Society of Anesthesiologists classification, body mass index, and pain. Secondary analyses of delayed discharge (>24 hours) and complications were also undertaken. Results: Forty women, aged 28 to 69 years, were included in this study. There was no statistically significant difference between the preoperative and postoperative day 7 Quality of Recovery-27 questionnaire scores, suggesting that our patients recovery to their preoperative state by postoperative day 7. Poorer total Quality of Recovery-27 questionnaire scores were associated with higher American Society of Anesthesiologists classification, low and high body mass indexes (U-shaped relationship), and higher pain scores. Conclusion: Patients undergoing an ambulatory pathway of care for autologous breast reconstruction demonstrate acceptable quality of recovery. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.