Enhanced Recovery after Surgery (ERAS) protocols in breast cancer patients undergoing post-mastectomy breast reconstruction with tissue expander

Abstract

A lot of women choose the immediate breast reconstruction after mastectomy. The most common method is breast reconstruction using tissue expanders. Women's way of life and the economic crisis have created the need for adopting enhanced recovery after surgery (ERAS) protocols and early hospital discharge. The present study aims at informing perioperative nurses about the ERAS protocols and encouraging their implementation. ERAS protocols in breast cancer patients undergoing immediate post-mastectomy breast reconstruction include a combination of evidence-based interoperative interventions with the participation of surgeons, anesthetists, nurses, physiotherapists, and dietitians as members of the multidisciplinary team. This is a multifactorial approach to postoperative rehabilitation and care of the surgical patient. ERAS protocols are easy to apply, reduce morbidity, perioperative anxiety, postoperative pain, postoperative complications and hospitalization. In addition, they reduce the cost of treatment and hospitalization. The patient's approach to breast cancer following an ERAS protocol is divided into three phases: pre-surgical, intraoperative and post-operative. It starts before the patient’s hospitalization and continues until they are discharged, requiring active participation throughout the process. The total average hospitalization for post-mastectomy rehabilitation decreased from 3.6 days, prior to ERAS implementation, to 0 (discharging the same day) to 1.2 days post-surgery, releasing 30% of the beds. In conclusion, the ERAS protocols, following evidence-based perioperative care, promote the rapid recovery of patients aiming at reducing post-operative stress and its effects.

Developing an enhanced recovery after surgery program for oncology patients who undergo hip or knee reconstruction surgery

“…ERAS protocols recommend shortening the pre-operative fasting time; clear fluid fasting for 2 h and solid food fasting for 6 h before surgery are enough for most patients. Patients with gastroparesis, esophageal achalasia or previous upper gastrointestinal surgery, morbid obesity and previous history of post-operative nausea and vomiting are excluded[ 38 , 39 ]. Pre-operative administration of oral carbohydrate drinks has been studied in recent years and shown to significantly improve insulin resistance without significant impact on the recovery time of patients undergoing hip or knee replacement surgery[ 40 - 42 ].…”

“…PONV is undoubtedly an unpleasant adverse effect, which is experienced by 20%-30% of surgical patients and 70% of high-risk patients (patients with gastroparesis, esophageal achalasia, dysphagia, neurological diseases, gastrointestinal surgery, Whipple procedure, gastrectomy, etc. )[ 38 ]. For the prevention and treatment of PONV, it is recommended to administer 4 mg IV infusion of ondansetron before induction of anesthesia and metoclopramide half an hour before awakening.…”