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 .
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 .
Abstinence From Smoking Reduces Incisional Wound Infection: A Randomized Controlled Trial
Objective Clinical studies show that the incidence of postoperative wound complications is higher in smokers than nonsmokers . In this study , we evaluated the effect of abstinence from smoking on incisional wound infection . Methods Seventy-eight healthy subjects ( 48 smokers and 30 never-smokers ) were included in the study and followed for 15 weeks . In the first week of the study , the smokers smoked 20 cigarettes per day . Subsequently , they were r and omized to continuous smoking , abstinence with transdermal nicotine patch ( 25 mg per day ) , or abstinence with placebo patch . At the end of the first week and 4 , 8 , and 12 weeks after r and omization , incisional wounds were made lateral to the sacrum to excise punch biopsy wounds . At the same time identical wounds were made in 6 never-smokers . In 24 never-smokers a wound was made once . All wounds were followed for 2 weeks for development of wound complications . Results A total of 228 wounds were evaluated . In smokers the wound infection rate was 12 % ( 11 of 93 wounds ) compared with 2 % ( 1 of 48 wounds ) in never-smokers ( P < 0.05 ) . Wound infections were significantly fewer in abstinent smokers compared with continuous smokers after 4 , 8 , and 12 weeks after r and omization . No difference between transdermal nicotine patch and placebo was found . Conclusions Smokers have a higher wound infection rate than never-smokers and 4 weeks of abstinence from smoking reduces the incidence of wound infections
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 .
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 .