JosephDayanMD

[JosephDayanMD @JosephDayanMD]

@shujashafqatmd @disaj3 @prsjournal @JordanFreyMD @ChadPurnellMD @drchrysopoulo @DrRodRohrich @drkarenhorton @OlivierBranford @CaseyKraftMD @drheatherfurnas @6state Thank you so much it was an honor and a pleasure!

[JosephDayanMD @JosephDayanMD]

@AraSalibianMD @disaj3 Pain and recovery have been a barrier to microsurgical breast reconstruction. Enhanced recovery makes this a much kinder option for women!

[JosephDayanMD @JosephDayanMD]

@prsjournal @KateSBoehm @disaj3 Initial response was varied but over time good results and happy patients makes this easier to adopt

[JosephDayanMD @JosephDayanMD]

@AraSalibianMD @disaj3 Hourly Doppler checks or continuous tissue oximetry in PACU overnight then transferred to the DIEP flap floor.

[JosephDayanMD @JosephDayanMD]

@JuhaKii @RajaMohanMD @disaj3 Patients who do not want paravertebral blocks get pec/serratus blocks with liposomal bupivacaine intraop by the plastic surgeon at MSKCC

[JosephDayanMD @JosephDayanMD]

@shujashafqatmd @disaj3 Yes! We routinely use this approach for other types of micro breast recon. Narcotics alone can make patients feel doped up, nauseous, etc.

[JosephDayanMD @JosephDayanMD]

@JordanFreyMD @disaj3 Team up with your anesthesia, nursing, and PA colleagues and empower them to create an enhanced recovery protocol together. Know the data

[JosephDayanMD @JosephDayanMD]

@ChadPurnellMD @disaj3 We approached this as a team and asked our anesthesiologists how best to address goal directed fluid management looking at supporting data

[JosephDayanMD @JosephDayanMD]

@DrNikkiPhillips @disaj3 Expectations likely affect length of stay, would be interesting to study. Pain, narcotic requirements, nausea, etc probably do not

[JosephDayanMD @JosephDayanMD]

@RajaMohanMD @disaj3 600 mg gabapentin preop, paravertebral blocks (or pectoralis/serratis injection of liposomal bupivacaine intraop) diclofenac postop

[JosephDayanMD @JosephDayanMD]

@RajaMohanMD @prsjournal @disaj3 We do the TAP blocks ourselves, it's quick because the anatomy is fully exposed.

[JosephDayanMD @JosephDayanMD]

@shujashafqatmd Different types of pain (neuropathic/surgical/inflammatory) respond to different meds (gabapentin/opioid/NSAID)

[JosephDayanMD @JosephDayanMD]

@ChadPurnellMD @disaj3 That potential risk is weighed against starving a patient for 2 nights-not easy. We have not observed any complications of early feeding.

[JosephDayanMD @JosephDayanMD]

@PatMcGuireMD @FrancescoEgro @disaj3 @prsjournal Yes good point!--patients receive 40 mg enoxaparin preop then daily in hospital. High risk patients get prophylaxis for 1 month

[JosephDayanMD @JosephDayanMD]

@sammysinnoMD @disaj3 @prsjournal @JordanFreyMD @AraSalibianMD @IraSavetskyMD @OlivierBranford @drheatherfurnas @drkarenhorton @DavidAHidalgoMD @DrRodRohrich @shujashafqatmd Goal was to avoid making women look like ICU patients after a flap with a PCA, and more like a healthy patients recovering from surgery

[JosephDayanMD @JosephDayanMD]

@sammysinnoMD @disaj3 @prsjournal @JordanFreyMD @AraSalibianMD @IraSavetskyMD @OlivierBranford @drheatherfurnas @drkarenhorton @DavidAHidalgoMD @DrRodRohrich @shujashafqatmd Thank you! everyone wants to see patients do better--team approach with some time and education made this reality in less than 6 months

[JosephDayanMD @JosephDayanMD]

@AmandaKSilvaMD @rajparikhmd @JordanFreyMD High BMI, sedentary, personal or family history of DVT/PE, age > 60, smoking, hormonal therapy are among factors associated with VTE

[JosephDayanMD @JosephDayanMD]

@AmandaKSilvaMD Enhanced recovery approach involving early extubation is currently being investigated at MSKCC

[JosephDayanMD @JosephDayanMD]

@AmandaKSilvaMD @disaj3 Yes we frequently use colloid up front to minimize fluid overload with crystalloid. Goal is euvolemia, not hypervolemia.

[JosephDayanMD @JosephDayanMD]

@AmandaKSilvaMD @pallabc @disaj3 Foley comes out morning of postop day one. Fluids are also heplocked. Patients are free of all lines POD 1 and encouraged to walk