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 .
Improved Recovery Experience Achieved for Women Undergoing Implant-Based Breast Reconstruction Using an Enhanced Recovery after Surgery Model
Background : Enhanced recovery after surgery was compared with traditional recovery after surgery for postmastectomy alloplastic breast reconstruction . Methods : Length of stay , emergency room visits , and complications within 30 days of surgery were compared among three groups : traditional recovery after surgery , transition ( some elements of enhanced recovery protocol , not transitioned to outpatient care ) , and enhanced recovery after surgery ( day surgery , provided with st and ardized perioperative education and multimodal analgesia ) . Prospect i ve data collection allowed quality -of-recovery assessment using a vali date d question naire for enhanced recovery/transition groups . Results were statistically analyzed ( analysis of variance/chi-square ) . Results : The traditional recovery , transition , and enhanced recovery cohorts comprised 29 , 11 , and 29 patients , respectively . No significant differences were present regarding age , smoking status , preoperative radiation , single stage direct-to-implant versus tissue exp and er , bilateral versus unilateral surgery , or immediate versus delayed reconstruction among groups . Average length of stay was 1.6 nights in both the traditional recovery and transition groups , compared with 0 nights in the enhanced recovery group ( p < 0.001 ) . Enhanced recovery patients had less severe pain ( p = 0.02 ) and nausea ( p = 0.01 ) , and better enjoyed their food ( p = 0.0002 ) and felt more rested ( p = 0.02 ) than their transition counterparts . There were no differences in the number of emergency room visits among the three groups ( p = 0.88 ) . There was no difference in the rate of hematoma ( p = 0.36 ) , infection requiring intravenous antibiotics ( p = 0.36 ) , or infection requiring explantation ( p = 0.36 ) among the three groups . Conclusion : An enhanced recovery protocol for alloplastic breast reconstruction treated patients safely , with improved patient satisfaction and same-day discharge and with no increase in complications . CLINICAL QUESTION /LEVEL OF EVIDENCE : Therapeutic , III
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 .