Oral Presentation NZAPS and ANZSOPS Joint Scientific Meeting

Enhanced recovery after surgery (ERAS) protocol in microvascular breast reconstruction based on a 2 year case review (637)

Andrew Sanders 1 , Meredith Simcock 1 , John Kenealy 1 , Michelle Locke 1
  1. CMDHB, Auckland, AUCKLAND, New Zealand

The benefits of enhanced recovery after surgery (ERAS) protocols have been established in multiple surgical specialties including reduced analgesia requirements and shorter length of hospital stay. Microvascular breast reconstruction is a prolonged operation with associated risks of pain, decreased mobility, and physiologic alterations. An ERAS pathway addresses these key factors that keep a patient hospitalised and provides coordinated guidance for the whole perioperative team. We reviewed 2 years of consecutive free flap breast reconstructions performed at Middlemore Hospital to determine the current standard of care and variations in practice within our institution to aid development of an ERAS protocol. RESULTS: 63 women underwent breast reconstruction during 2014-15 – mean age 48, BMI 28, Length of stay 6.2 days. Local anaesthetic, enteral and parenteral analgesia use was inconsistent. 81% of patients were prescribed a postoperative morphine PCA which continued for an average of 1.6 days. Other pain medications prescribed included paracetamol (95%) gabapentin (57%), NSAIDs (65%), and a variety of opioid medication. DISCUSSION: Our 2 year traditional recovery review highlights the lack of a standardised pathway for this group of patients undergoing major surgery. Analysis of this heterogenous data set and review of current literature was utilised to create an ERAS protocol post breast reconstruction for Middlemore Hospital. This is now established and a prospective review of the perioperative outcomes is being undertaken for comparison.