Consensus review of optimal perioperative care in breast reconstruction: Enhanced recovery after surgery (ERAS) society recommendations Journal Article


Authors: Temple-Oberle, C.; Shea-Budgell, M. A.; Tan, M.; Semple, J. L.; Schrag, C.; Barreto, M.; Blondeel, P.; Hamming, J.; Dayan, J.; Ljungqvist, O.
Article Title: Consensus review of optimal perioperative care in breast reconstruction: Enhanced recovery after surgery (ERAS) society recommendations
Abstract: Background: Enhanced recovery following surgery can be achieved through the introduction of evidence-based perioperative maneuvers. This review aims to present a consensus for optimal perioperative management of patients undergoing breast reconstructive surgery and to provide evidence-based recommendations for an enhanced perioperative protocol. Methods: A systematic review of meta-analyses, randomized controlled trials, and large prospective cohorts was conducted for each protocol element. Smaller prospective cohorts and retrospective cohorts were considered only when higher level evidence was unavailable. The available literature was graded by an international panel of experts in breast reconstructive surgery and used to form consensus recommendations for each topic. Each recommendation was graded following a consensus discussion among the expert panel. Development of these recommendations was endorsed by the Enhanced Recovery after Surgery Society. Results: High-quality randomized controlled trial data in patients undergoing breast reconstruction informed some of the recommendations; however, for most items, data from lower level studies in the population of interest were considered along with extrapolated data from high-quality studies in non-breast reconstruction populations. Recommendations were developed for a total of 18 unique enhanced recovery after surgery items and are discussed in the article. Key recommendations support use of opioid-sparing perioperative medications, minimal preoperative fasting and early feeding, use of anesthetic techniques that decrease postoperative nausea and vomiting and pain, use of measures to prevent intraoperative hypothermia, and support of early mobilization after surgery. Conclusion: Based on the best available evidence for each topic, a consensus review of optimal perioperative care for patients undergoing breast reconstruction is presented. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V. Copyright © 2017 by the American Society of Plastic Surgeons.
Journal Title: Plastic and Reconstructive Surgery
Volume: 139
Issue: 5
ISSN: 0032-1052
Publisher: Lippincott Williams & Wilkins  
Date Published: 2017-05-01
Start Page: 1056e
End Page: 1071e
Language: English
DOI: 10.1097/prs.0000000000003242
PROVIDER: scopus
PUBMED: 28445352
DOI/URL:
Notes: Conference Paper -- Export Date: 3 July 2017 -- Source: Scopus
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  1. Joseph Henry Dayan
    101 Dayan