{"id":"https://openalex.org/W4384297400","doi":"https://doi.org/10.1097/sap.0000000000003578","title":"Significant Reduction in Length of Stay in Deep Inferior Epigastric Perforator Flap Breast Reconstruction With Implementation of Multimodal ERAS Protocol","display_name":"Significant Reduction in Length of Stay in Deep Inferior Epigastric Perforator Flap Breast Reconstruction With Implementation of Multimodal ERAS Protocol","publication_year":2023,"publication_date":"2023-07-01","ids":{"openalex":"https://openalex.org/W4384297400","doi":"https://doi.org/10.1097/sap.0000000000003578","pmid":"https://pubmed.ncbi.nlm.nih.gov/37450866","pmcid":"https://www.ncbi.nlm.nih.gov/pmc/articles/10575614"},"language":"en","primary_location":{"id":"doi:10.1097/sap.0000000000003578","doi":"https://doi.org/10.1097/sap.0000000000003578","is_oa":false,"landing_page_url":"https://doi.org/10.1097/sap.0000000000003578","pdf_url":null,"source":{"id":"https://openalex.org/S11131942","display_name":"Annals of Plastic Surgery","issn_l":"0148-7043","issn":["0148-7043","1536-3708"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-scientific","cwts-core","dongbi-d","doyens","jufo-1","ki-jl-1","medline","norway-1","poland-70","russia-white-list-2"],"host_organization":"https://openalex.org/P4310315671","host_organization_name":"Lippincott Williams & Wilkins","host_organization_lineage":["https://openalex.org/P4310315671","https://openalex.org/P4310318547"],"host_organization_lineage_names":["Lippincott Williams & Wilkins","Wolters Kluwer"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Annals of Plastic Surgery","raw_type":"journal-article"},"volume":null,"type":"article","indexed_in":["crossref","pubmed"],"open_access":{"is_oa":true,"oa_status":"green","oa_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC10575614/pdf/nihms-1935818.pdf","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5018276399","display_name":"Sthefano Araya","orcid":"https://orcid.org/0000-0002-8245-8036","observed_orcids":["https://orcid.org/0000-0002-8245-8036"]},"institutions":[{"id":"https://openalex.org/I1289437631","display_name":"Fox Chase Cancer Center","ror":"https://ror.org/0567t7073","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I1289437631","https://openalex.org/I4210122924"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Sthefano Araya","raw_affiliation_strings":["Division of Plastic and Reconstructive Surgery, Fox Chase Cancer Center"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Division of Plastic and Reconstructive Surgery, Fox Chase Cancer Center","institution_ids":["https://openalex.org/I1289437631"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5041279727","display_name":"Theresa K. Webster","orcid":"https://orcid.org/0000-0002-5385-0530","observed_orcids":["https://orcid.org/0000-0002-5385-0530"]},"institutions":[{"id":"https://openalex.org/I84392919","display_name":"Temple University","ror":"https://ror.org/00kx1jb78","country_code":"US","type":"education","lineage":["https://openalex.org/I84392919"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Theresa K. Webster","raw_affiliation_strings":["Lewis Katz School of Medicine, Temple University"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Lewis Katz School of Medicine, Temple University","institution_ids":["https://openalex.org/I84392919"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5010363332","display_name":"Brian Lee Egleston","orcid":"https://orcid.org/0000-0002-1633-799X","observed_orcids":["https://orcid.org/0000-0002-1633-799X"]},"institutions":[{"id":"https://openalex.org/I1289437631","display_name":"Fox Chase Cancer Center","ror":"https://ror.org/0567t7073","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I1289437631","https://openalex.org/I4210122924"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Brian Egleston","raw_affiliation_strings":["Biostatistics and Bioinformatics Facility, Fox Chase Cancer Center"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Biostatistics and Bioinformatics Facility, Fox Chase Cancer Center","institution_ids":["https://openalex.org/I1289437631"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5018025616","display_name":"Grace M. Amadio","orcid":"https://orcid.org/0000-0001-6247-4904","observed_orcids":["https://orcid.org/0000-0001-6247-4904"]},"institutions":[{"id":"https://openalex.org/I84392919","display_name":"Temple University","ror":"https://ror.org/00kx1jb78","country_code":"US","type":"education","lineage":["https://openalex.org/I84392919"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Grace M. Amadio","raw_affiliation_strings":["Lewis Katz School of Medicine, Temple University"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Lewis Katz School of Medicine, Temple University","institution_ids":["https://openalex.org/I84392919"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5038943583","display_name":"Juliet C. Panichella","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I84392919","display_name":"Temple University","ror":"https://ror.org/00kx1jb78","country_code":"US","type":"education","lineage":["https://openalex.org/I84392919"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Juliet C. Panichella","raw_affiliation_strings":["Lewis Katz School of Medicine, Temple University"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Lewis Katz School of Medicine, Temple University","institution_ids":["https://openalex.org/I84392919"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5060878111","display_name":"Nicholas A. Elmer","orcid":"https://orcid.org/0000-0002-4878-3660","observed_orcids":["https://orcid.org/0000-0002-4878-3660"]},"institutions":[{"id":"https://openalex.org/I149251103","display_name":"Thomas Jefferson University","ror":"https://ror.org/00ysqcn41","country_code":"US","type":"education","lineage":["https://openalex.org/I149251103"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Nicholas A. Elmer","raw_affiliation_strings":["Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA","institution_ids":["https://openalex.org/I149251103"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5042594904","display_name":"Sameer A. Patel","orcid":"https://orcid.org/0000-0002-1924-9215","observed_orcids":["https://orcid.org/0000-0002-1924-9215","https://orcid.org/0009-0005-4423-4268"]},"institutions":[{"id":"https://openalex.org/I1289437631","display_name":"Fox Chase Cancer Center","ror":"https://ror.org/0567t7073","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I1289437631","https://openalex.org/I4210122924"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Sameer A. Patel","raw_affiliation_strings":["Division of Plastic and Reconstructive Surgery, Fox Chase Cancer Center"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Division of Plastic and Reconstructive Surgery, Fox Chase Cancer Center","institution_ids":["https://openalex.org/I1289437631"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":3,"corresponding_author_ids":[],"corresponding_institution_ids":[],"apc_list":null,"apc_paid":null,"fwci":5.6014,"has_fulltext":true,"cited_by_count":21,"citation_normalized_percentile":{"value":0.97040697,"is_in_top_1_percent":false,"is_in_top_10_percent":true},"cited_by_percentile_year":{"min":97,"max":99},"biblio":{"volume":"91","issue":"1","first_page":"90","last_page":"95"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T12020","display_name":"Enhanced Recovery After Surgery","score":0.9994999766349792,"subfield":{"id":"https://openalex.org/subfields/2746","display_name":"Surgery"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T12020","display_name":"Enhanced Recovery After Surgery","score":0.9994999766349792,"subfield":{"id":"https://openalex.org/subfields/2746","display_name":"Surgery"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11258","display_name":"Breast Implant and Reconstruction","score":0.00019999999494757503,"subfield":{"id":"https://openalex.org/subfields/2746","display_name":"Surgery"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10599","display_name":"Reconstructive Surgery and Microvascular Techniques","score":9.999999747378752e-05,"subfield":{"id":"https://openalex.org/subfields/2746","display_name":"Surgery"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/enhanced-recovery-after-surgery","display_name":"enhanced recovery after surgery","score":0.9760000109672546},{"id":"https://openalex.org/keywords/diep-flap","display_name":"DIEP flap","score":0.8389999866485596},{"id":"https://openalex.org/keywords/breast-reconstruction","display_name":"breast reconstruction","score":0.8240000009536743},{"id":"https://openalex.org/keywords/length-of-hospital-stay","display_name":"length of hospital stay","score":0.8320000171661377},{"id":"https://openalex.org/keywords/free-flap","display_name":"free flap","score":0.4259999990463257},{"id":"https://openalex.org/keywords/microsurgery","display_name":"microsurgery","score":0.6700000166893005},{"id":"https://openalex.org/keywords/postoperative-complications","display_name":"postoperative complications","score":0.5619999766349792},{"id":"https://openalex.org/keywords/flap-failure","display_name":"flap failure","score":0.7620000243186951},{"id":"https://openalex.org/keywords/eras-implementation","display_name":"ERAS implementation","score":0.6060000061988831}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.9823755025863647},{"id":"https://openalex.org/C2779628157","wikidata":"https://www.wikidata.org/wiki/Q2431964","display_name":"DIEP flap","level":5,"score":0.942177414894104},{"id":"https://openalex.org/C2781001896","wikidata":"https://www.wikidata.org/wiki/Q994507","display_name":"Breast reconstruction","level":4,"score":0.8154256343841553},{"id":"https://openalex.org/C141071460","wikidata":"https://www.wikidata.org/wiki/Q40821","display_name":"Surgery","level":1,"score":0.6895576119422913},{"id":"https://openalex.org/C2780084366","wikidata":"https://www.wikidata.org/wiki/Q37732","display_name":"Demographics","level":2,"score":0.5980366468429565},{"id":"https://openalex.org/C167135981","wikidata":"https://www.wikidata.org/wiki/Q2146302","display_name":"Retrospective cohort study","level":2,"score":0.5642492771148682},{"id":"https://openalex.org/C2779912925","wikidata":"https://www.wikidata.org/wiki/Q5871352","display_name":"Free flap","level":2,"score":0.5150153636932373},{"id":"https://openalex.org/C2779705553","wikidata":"https://www.wikidata.org/wiki/Q7168177","display_name":"Perforator flaps","level":2,"score":0.5033251643180847},{"id":"https://openalex.org/C81182388","wikidata":"https://www.wikidata.org/wiki/Q353963","display_name":"Complication","level":2,"score":0.4836248457431793},{"id":"https://openalex.org/C44249647","wikidata":"https://www.wikidata.org/wiki/Q208498","display_name":"Confidence interval","level":2,"score":0.47558557987213135},{"id":"https://openalex.org/C530470458","wikidata":"https://www.wikidata.org/wiki/Q128581","display_name":"Breast cancer","level":3,"score":0.28527218103408813},{"id":"https://openalex.org/C121608353","wikidata":"https://www.wikidata.org/wiki/Q12078","display_name":"Cancer","level":2,"score":0.09428074955940247},{"id":"https://openalex.org/C126322002","wikidata":"https://www.wikidata.org/wiki/Q11180","display_name":"Internal medicine","level":1,"score":0.0843375027179718},{"id":"https://openalex.org/C149923435","wikidata":"https://www.wikidata.org/wiki/Q37732","display_name":"Demography","level":1,"score":0.0},{"id":"https://openalex.org/C144024400","wikidata":"https://www.wikidata.org/wiki/Q21201","display_name":"Sociology","level":0,"score":0.0}],"mesh":[{"descriptor_ui":"D000080482","descriptor_name":"Enhanced Recovery After Surgery","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D007902","descriptor_name":"Length of Stay","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D012189","descriptor_name":"Retrospective Studies","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D016462","descriptor_name":"Mammaplasty","qualifier_ui":"Q000379","qualifier_name":"methods","is_major_topic":true},{"descriptor_ui":"D019074","descriptor_name":"Epigastric Arteries","qualifier_ui":"Q000601","qualifier_name":"surgery","is_major_topic":false},{"descriptor_ui":"D061525","descriptor_name":"Perforator Flap","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true}],"locations_count":3,"locations":[{"id":"doi:10.1097/sap.0000000000003578","doi":"https://doi.org/10.1097/sap.0000000000003578","is_oa":false,"landing_page_url":"https://doi.org/10.1097/sap.0000000000003578","pdf_url":null,"source":{"id":"https://openalex.org/S11131942","display_name":"Annals of Plastic Surgery","issn_l":"0148-7043","issn":["0148-7043","1536-3708"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-scientific","cwts-core","dongbi-d","doyens","jufo-1","ki-jl-1","medline","norway-1","poland-70","russia-white-list-2"],"host_organization":"https://openalex.org/P4310315671","host_organization_name":"Lippincott Williams & Wilkins","host_organization_lineage":["https://openalex.org/P4310315671","https://openalex.org/P4310318547"],"host_organization_lineage_names":["Lippincott Williams & Wilkins","Wolters Kluwer"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Annals of Plastic Surgery","raw_type":"journal-article"},{"id":"pmid:37450866","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/37450866","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Annals of plastic surgery","raw_type":"Journal Article"},{"id":"pmh:oai:pubmedcentral.nih.gov:10575614","doi":null,"is_oa":true,"landing_page_url":"https://www.ncbi.nlm.nih.gov/pmc/articles/10575614","pdf_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC10575614/pdf/nihms-1935818.pdf","source":{"id":"https://openalex.org/S2764455111","display_name":"PubMed Central","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"acceptedVersion","is_accepted":true,"is_published":false,"raw_source_name":"Ann Plast Surg","raw_type":"Text"}],"best_oa_location":{"id":"pmh:oai:pubmedcentral.nih.gov:10575614","doi":null,"is_oa":true,"landing_page_url":"https://www.ncbi.nlm.nih.gov/pmc/articles/10575614","pdf_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC10575614/pdf/nihms-1935818.pdf","source":{"id":"https://openalex.org/S2764455111","display_name":"PubMed Central","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"acceptedVersion","is_accepted":true,"is_published":false,"raw_source_name":"Ann Plast Surg","raw_type":"Text"},"sustainable_development_goals":[{"display_name":"Good health and well-being","score":1.0,"id":"https://metadata.un.org/sdg/3"}],"study_designs":[{"display_name":"Observational Study","id":"https://openalex.org/study-designs/observational-study"}],"awards":[{"id":"https://openalex.org/G9000285491","display_name":"Comprehensive Cancer Center Program at Fox Chase","funder_award_id":"P30CA006927","funder_id":"https://openalex.org/F4320337351","funder_display_name":"National Cancer Institute"}],"funders":[{"id":"https://openalex.org/F4320332161","display_name":"National Institutes of Health","ror":"https://ror.org/01cwqze88"},{"id":"https://openalex.org/F4320337351","display_name":"National Cancer Institute","ror":"https://ror.org/040gcmg81"}],"has_content":{"grobid_xml":true,"pdf":true},"content_urls":{"pdf":"https://content.openalex.org/works/W4384297400.pdf","grobid_xml":"https://content.openalex.org/works/W4384297400.grobid-xml"},"referenced_works_count":25,"referenced_works":["https://openalex.org/W2004218393","https://openalex.org/W2016190281","https://openalex.org/W2054927255","https://openalex.org/W2299415861","https://openalex.org/W2525813369","https://openalex.org/W2577055980","https://openalex.org/W2588351395","https://openalex.org/W2740995161","https://openalex.org/W2748617594","https://openalex.org/W2789899272","https://openalex.org/W2791758114","https://openalex.org/W2895982061","https://openalex.org/W2896462385","https://openalex.org/W2900168121","https://openalex.org/W2943055610","https://openalex.org/W2946498003","https://openalex.org/W2946924919","https://openalex.org/W2953845074","https://openalex.org/W2964170332","https://openalex.org/W2996043925","https://openalex.org/W3008621238","https://openalex.org/W3080152127","https://openalex.org/W3212593258","https://openalex.org/W4200048817","https://openalex.org/W4229754777"],"related_works":["https://openalex.org/W7154470945","https://openalex.org/W3195021958","https://openalex.org/W4214674571","https://openalex.org/W3153060767","https://openalex.org/W4405925206","https://openalex.org/W7125530310","https://openalex.org/W4407753816","https://openalex.org/W4411112250","https://openalex.org/W7009738755","https://openalex.org/W4387653066"],"abstract_inverted_index":{"BACKGROUND:":[0],"Enhanced":[1],"Recovery":[2],"After":[3,95],"Surgery":[4],"(ERAS)":[5],"implementation":[6,210],"achieves":[7],"earlier":[8],"recovery,":[9],"reduced":[10],"hospital":[11],"length":[12,118],"of":[13,53,62,119,127,160,174,211],"stay":[14,120,128],"(LOS)":[15],"and":[16,36,77],"improved":[17],"outcomes":[18],"in":[19,117,144,156,162,176,204,222,237],"patients":[20,63,89,161,175],"undergoing":[21,64],"deep":[22],"inferior":[23],"epigastric":[24],"perforator":[25],"(DIEP)":[26],"free":[27],"flaps.":[28],"We":[29],"sought":[30],"to":[31,60,110,123,146,242],"review":[32,52],"our":[33,40,212],"ERAS":[34,97,213,231],"protocols":[35,232],"their":[37],"impact":[38],"on":[39,136,148,195],"patients'":[41],"LOS":[42,70,225,246],"compared":[43,171,199,226],"with":[44,69,172,200,227],"the":[45,72,205],"literature.":[46,207,229],"METHODS:":[47],"This":[48],"was":[49],"a":[50,54,102,187,223,244],"retrospective":[51],"single":[55],"surgeon's":[56],"experience":[57],"from":[58,132],"2017":[59,145,177],"2021":[61,163],"DIEP":[65,91,216,239],"free-flap":[66,92,217],"breast":[67,93,218,240],"reconstruction":[68,219,241],"as":[71,82],"primary":[73],"outcome.":[74],"Complication":[75],"rates":[76],"patient":[78,185,249],"demographics":[79],"are":[80],"described":[81],"secondary":[83],"outcomes.":[84,250],"RESULTS:":[85],"One":[86,184],"hundred":[87],"twenty-one":[88],"underwent":[90],"reconstruction.":[94],"adapting":[96],"protocols,":[98],"there":[99],"has":[100,129,220],"been":[101],"0.98":[103],"[SD,":[104],"0.17;":[105],"confidence":[106],"interval":[107],"[CI],":[108],"-1.3":[109],"-0.64;":[111],"P":[112],"<":[113],"0.001)":[114],"day":[115,137,149],"decrease":[116],"comparing":[121],"pre-ERAS":[122],"post-ERAS":[124],"implementation.":[125],"Length":[126],"routinely":[130],"decreased":[131],"an":[133],"average":[134],"discharge":[135,147,194],"4.17":[138],"(SD,":[139,151],"1.1;":[140,152],"range,":[141,153],"3-8":[142],"days)":[143,155],"2.91":[150],"1-5":[154],"2021.":[157],"Seventy-five":[158],"percent":[159],"were":[164],"hospitalized":[165,178],"for":[166,179,215],"3":[167],"or":[168,181],"fewer":[169],"days":[170,197,202],"75%":[173],"4":[180],"more":[182],"days.":[183],"experienced":[186],"flap":[188],"failure.":[189],"Our":[190],"study":[191],"supports":[192],"successful":[193],"postoperative":[196,201],"2-3":[198],"3-4":[203],"current":[206],"CONCLUSIONS:":[208],"The":[209,230],"protocol":[214],"resulted":[221],"shorter":[224,245],"contemporary":[228],"can":[233],"be":[234],"efficiently":[235],"adopted":[236],"microsurgical":[238],"achieve":[243],"without":[247],"jeopardizing":[248]},"counts_by_year":[{"year":2026,"cited_by_count":5},{"year":2025,"cited_by_count":7},{"year":2024,"cited_by_count":5},{"year":2023,"cited_by_count":4}],"updated_date":"2026-10-31T12:09:11.096373","created_date":"2023-07-15T00:00:00"}