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 .
Pre-consultation educational group intervention to improve shared decision-making for postmastectomy breast reconstruction: a pilot randomized controlled trial
Purpose Breast cancer survivors who make preference-sensitive decisions about postmastectomy breast reconstruction often have large gaps in knowledge and undergo procedures that are misaligned with their treatment goals . We evaluated the feasibility and effect of a pre-consultation educational group intervention on the decision-making process for breast reconstruction . Methods We conducted a pilot r and omized controlled trial ( RCT ) where participants were r and omly assigned to the intervention with routine education or routine education alone .  The outcomes evaluated were decisional conflict , decision self-efficacy , satisfaction with information , perceived involvement in care , and uptake of reconstruction following surgical consultation . Trial feasibility and acceptability were evaluated , and effect sizes were calculated to determine the primary outcome for the full-scale RCT . Results Of the 41 patients enrolled , recruitment rate was 72 % , treatment fidelity was 98 % , and retention rate was 95 % . The Cohen ’s d effect size in reduction of decisional conflict was moderate to high for the intervention group compared to routine education ( 0.69 , 95 % CI = 0.02–1.42 ) , while the effect sizes of increase in decision self-efficacy ( 0.05 , 95 % CI = −0.60–0.71 ) and satisfaction with information ( 0.11 , 95 % CI = −0.53–0.76 ) were small . A higher proportion of patients receiving routine education signed informed consent to undergo breast reconstruction ( 14/20 or 70 % ) compared to the intervention group ( 8/21 or 38 % ) P = 0.06 . Conclusions A pre-consultation educational group intervention  improves patients ’ shared decision-making quality compared to routine preoperative patient education . A full-scale definitive RCT is warranted based on high feasibility outcomes , and the primary outcome for the main trial will be decisional conflict
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 .