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 .
The Role of Chronic and Perioperative Glucose Management in High-Risk Surgical Closures: A Case for Tighter Glycemic Control
Background : The exact risk that poor glucose control introduces to patients undergoing surgical closure has yet to be fully defined . Methods : The authors retrospectively analyzed a prospect ively collected data base of patients seen at their wound care center to evaluate the effects of chronic and perioperative glucose control in high-risk patients undergoing surgical wound closure .  Hemoglobin A1c and blood glucose levels for the 5 days before and after surgical closure were recorded and compared with the primary endpoints of dehiscence , infection , and reoperation . Univariate and multivariate analyses were performed . Results : Seventy-nine patients had perioperative glucose levels and 64 had hemoglobin A1C levels available for analysis . Preoperative and postoperative hyperglycemia ( defined as any blood glucose measurement above 200 mg/dl ) as well as elevated A1C levels ( above 6.5 percent or 48 mmol/ml ) were significantly associated with increased rates of dehiscence ( odds ratio , 3.2 , p = 0.048 ; odds ratio , 3.46 , p = 0.028 ; and odds ratio , 3.54 , p = 0.040 , respectively ) . Variability in preoperative glucose ( defined as a range of glucose levels exceeding 200 points ) was significantly associated with increased rates of reoperation ( odds ratio , 4.14 , p = 0.025 ) and trended toward significance with increased rates of dehiscence ( p = 0.15 ) . In multivariate regression , only perioperative hyperglycemia and elevated A1c were significantly associated with increased rates of dehiscence . Conclusions : In primary closure of surgical wounds in high-risk patients , poor glycemic control is significantly associated with worse outcomes . Every effort should be made to ensure tight control in both the chronic and subacute perioperative periods . CLINICAL QUESTION /LEVEL OF EVIDENCE : Risk , II
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 .