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 .
Risk analysis and stratification of surgical morbidity after immediate breast reconstruction.
BACKGROUND  Surgical complications after breast reconstruction can be associated with significant morbidity , dissatisfaction , and cost . We used the ACS-NSQIP data sets from 2005 to 2011 to derive predictors of morbidity and to stratify risk after immediate breast reconstruction ( IBR ) . STUDY DESIGN Surgical complications after implant and autologous reconstruction were assessed using the ACS-NSQIP 2005 to 2011 data sets . Patient demographics , clinical characteristics , and operative factors were associated with the likelihood of experiencing a surgical complication . A " model cohort " of 12,129 patients was r and omly selected from the study cohort to derive predictors . Weighted odds ratios derived from logistic regression analysis were used to create a composite risk score and to stratify patients . The remaining one-third of the cohort ( n = 6,065 ) were used as the " validation cohort " to assess the accuracy value of the risk model . RESULTS On adjusted analysis , autologous reconstruction ( odds ratio [ OR ] 1.41 , p < 0.001 ) , American Society of Anesthesiologists physical status ≥ 3 ( OR 1.25 , p = 0.004 ) , class I obesity ( OR 1.38 , p < 0.001 ) , class II obesity ( OR 1.91 , p < 0.001 ) , class III obesity ( OR 1.70 , p < 0.001 ) , and active smoking ( OR 1.46 , p < 0.001 ) were associated with complications . Risk factors were weighted and patients were stratified into low ( 0 to 2 , n = 9,133 , risk = 7.14 % ) , intermediate ( 3 to 4 , n = 1,935 , risk = 10.90 % ) , high ( 5 to 7 , n = 1,024 , risk = 16.70 % ) , and very high ( 8 to 9 , n = 37 , risk = 27.02 % ) risk categories based on their total risk score ( p < 0.001 ) . Internal validation of the " model cohort " using the " validation cohort " was performed demonstrating accurate prediction of risk across groups : low ( 7.1 % vs 7.1 % , respectively , p = 0.9 ) , intermediate ( 10.9 % vs 12.0 % , respectively , p = 0.38 ) , high ( 16.7 % vs 16.8 % , respectively , p = 0.95 ) , and very high ( 27.0 % vs 30.0 % , respectively , p = 1.0 ) . CONCLUSIONS Surgical complications after IBR are related to preoperatively identifiable factors that can be used to accurately risk stratify patients , which may assist with counseling , selection , and perioperative decision-making
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 .