Enhanced Recovery After Free Functional Gracilis Muscle Transfer for Smile Reanimation
Keisha J Barrera, BS1 and Nate Jowett, MD, PhD2, 1Mass Eye and Ear Infirmary, Boston, MA, 2Harvard Medical School / Mass Eye and Ear, Boston, MA
Background: Enhanced recovery after surgery (ERAS) pathways yield improved patient experience and cost savings. Opioid sparing analgesia and short hospital admissions are hallmarks of ERAS pathways. This retrospective matched cohort study compares clinical outcomes of patients undergoing free functional gracilis muscle transfer for smile reanimation before and after implementation of opioid-sparing analgesia and short hospital admissions during the COVID19 pandemic.
Methods: Clinical outcomes including complication and success rates, post anesthesia care unit (PACU) length of stay, morphine milligram equivalent [MME], pain scores, and admission duration among a continuous cohort of adult and pediatric patients undergoing ERAS pathway free functional gracilis muscle transfer (N=59) were compared against non-ERAS pathway matched controls (N=59).
Results: No statistical differences were observed between ERAS and non-ERAS groups for baseline characteristics (age, body mass index, ASA status, and type of facial paralysis), rate of post-operative nausea-vomiting (16.9% vs 25.4%), nor rates of hematoma (3.5% vs 9.3%), infection (6.8% vs 1.7%), or procedural success (83.3% vs 76.3%). There were significant decreases for ERAS pathway patients compared to non-ERAS pathway for length of hospital stay (1.0 dy vs 3.0 dy, p < 0.001), inpatient MME (10.0 mg vs. 33.0 mg, p<0.001), and reported pain levels (2.54 vs 3.44, p = 0.021). PACU time was significantly decreased among patients given pre-operative opioid sparing analgesics comprising NSAIDs, acetaminophen, and gabapentin (86 min vs. 106 min, p =0.036).
Conclusion: An ERAS pathway for free functional gracilis muscle transfer yields decreased opioid consumption and decreased PACU and hospital admission length of stay, without significant increased risk of morbidity or procedural failure.
Back to 2024 Abstracts