A Modified Enhanced Recovery after Surgery (ERAS): Use and Surgical Outcome in Breast Cancer Patients

Abstract

Background: ERAS protocols are perioperative interventions aimed at reducing postoperative complications, length of hospital stay (LOS) and early return to normal activities. This has improved outcome in many surgical specialties, including breast surgery. We present the surgical outcome of breast cancer (BC) patients treated over a 12-month period following the principle of ERAS protocols and highlight the underpinning evidence. Methods: A retrospective analysis of all BC patients diagnosed and had breast cancer surgery over 12 months. Data collected included patient's demographics, type of surgery, LOS, other perioperative care and significant postoperative complications. Excluded were patients with bilateral cancer surgeries, diagnostic excision, margin clearance or breast reconstruction. Results: There were 621 BC diagnosed including 5 male and 12 bilateral female BC. The ages ranged from 25 to 93 years. Excluding bilateral BC, 351 patients (70.2 %) had breast conserving surgery (BCS) while 149 (29.8%) patients had mastectomy as index cancer surgery. Sixteen (4.5%) of the women who initially underwent BCS subsequently had a completion mastectomy. The overall rate of successful BCS was 335/500 (67%). 441 (85.5%) of patients were discharged same or next day. 12 (7.2%) cases of postoperative haematoma, 6 cases of wound infection and a case of seroma requiring surgical/radiological drainage recorded. Conclusion: ERAS protocol in BC surgery is associated with decreased LOS and low complication rate. Delayed discharges are mostly due to adverse social factors and medical comorbidity rather than post-operative surgical complications.

Nonsteroidal anti-inflammatory drugs and pain in cancer patients: a systematic review and reappraisal of the evidence

“…65,66 With emerging evidence for the benefits of enhanced recovery after surgery (ERAS) pathways and the shift towards multi-modal analgesia, NSAIDs are currently recommended in an array of pathways and protocols. 74,75 A systematic review investigating the specific role NSAIDs have in both pre-emptive and preventative analgesia for all types of surgery is currently being conducted, 76 the results of which are keenly anticipated. Perhaps the predominant factors in the underutilisation of NSAIDs perioperatively relate to concerns about potential adverse consequences: risk of increased blood loss, acute kidney injury, anastomotic leak, and deleterious effects on bone healing.…”

Preparation of Fe-Cu-Based Friction Material and its Adoption in Automobile Mechanical Mechanism

“…After the sample is ground and polished, the hardness of the material is measured via the HV-120 Vickers hardness tester. The actual density of the sample is tested following the Archimedes' drainage principle [5]. The actual density calculation equation is as follows.…”

ASO Author Reflections: Improvement in Postoperative Pain, Nausea, and Vomiting After Implementation of an Enhanced Recovery Protocol for Breast Surgery

“…The results of this study are consistent with those of other recently reported studies describing multimodal ERP for breast cancer surgery. 2,4,5 However, a unique characteristic of the current study was the observation that not only can postoperative analgesia be achieved with a decreased opioid requirement, but that it also in turn results in a decrease in PONV, a significant problem in breast surgery. One important limitation of the currently available literature including the authors' experience is a lack of reported post-discharge pain scoring, opioid consumption, and antiemetic consumption.…”