74 Lessons Learned From a Breast Surgery ERAS Program in an Oncologic Ambulatory Center

Publication
Article
Miami Breast Cancer Conference® Abstracts Supplement42nd Annual Miami Breast Cancer Conference® - Abstracts
Volume 39
Issue 4
Pages: 56

74 Lessons Learned From a Breast Surgery ERAS Program in an Oncologic Ambulatory Center

74 Lessons Learned From a Breast Surgery ERAS Program in an Oncologic Ambulatory Center

Background/Significance

Enhanced Recovery After Surgery (ERAS) protocols have revolutionized surgical care, aiming to optimize patient outcomes and reduce recovery time. In the realm of breast surgery, ERAS implementation in an ambulatory setting presents unique challenges and opportunities. Key components of the ERAS protocol included multimodal pain management, early mobilization, postoperative nausea and vomiting (PONV) prophylaxis, and optimized fluid management. Several elements were updated over the years. This study aims to share our experiences and lessons learned from implementing an ERAS program for breast surgery in a high-volume ambulatory center.

Design and Methods

We retrospectively reviewed 8721 patients who underwent breast surgery between January 2016 and December 2023. The cases were performed with an ERAS protocol. We collected data on surgical volume, intraoperative and postoperative opioids measured in morphine milligram equivalents (MME), length of stay, PONV, and postoperative complications, which included transfers to main hospital and 30-day urgent care center visits.

Status

The volume increased 47% between 2016 and 2023. The implementation of the ERAS protocol resulted in significant reductions in intraoperative and postoperative opioid requirement (29% and 19%), PONV (41%), transfer (49%), 30-day urgent care center visits (43%), and 30-day readmissions (37%). There were no significant changes to length of stay.

The ERAS protocol implementation and improvement was associated with reduction in adverse outcomes despite substantial increase in the volume of cases. ERAS implementation in an ambulatory setting for breast surgery is feasible and can lead to substantial benefits for patients. However, challenges such as education, adherence to preoperative fasting guidelines, and managing unexpected complications remain. By addressing the unique challenges and tailoring the protocol to the ambulatory setting, optimal outcomes can be achieved. Future research should focus on further refining ERAS protocols and exploring innovative strategies to enhance patient outcomes.

Articles in this issue

56 Paternal vs Maternal Inheritance of a BRCA Mutation: Is There a Difference in Presentation and Stage of Breast Cancer at Diagnosis?
56 Paternal vs Maternal Inheritance of a BRCA Mutation: Is There a Difference in Presentation and Stage of Breast Cancer at Diagnosis?
57 Tumor Morphology Concordance in Multifocal/Multicentric Triple- Negative and HER2+ Breast Cancers
57 Tumor Morphology Concordance in Multifocal/Multicentric Triple- Negative and HER2+ Breast Cancers
59 Are Choosing Wisely Guidelines Applicable to Patients With a High Ki-67 Proliferation Index and Magee Equation Score?
59 Are Choosing Wisely Guidelines Applicable to Patients With a High Ki-67 Proliferation Index and Magee Equation Score?
60 Nipple-Sparing Mastectomy in Patients With BRCA and Other Breast Cancer–Related Gene Mutations
60 Nipple-Sparing Mastectomy in Patients With BRCA and Other Breast Cancer–Related Gene Mutations
61 Can the Use of Tumor Margin Markers for Intraoperative Specimen Radiographs Decrease the Rate of Margin Positivity During Breast Conservation Therapy?
61 Can the Use of Tumor Margin Markers for Intraoperative Specimen Radiographs Decrease the Rate of Margin Positivity During Breast Conservation Therapy?
63 Intraoperative Radiation and External Beam Radiation After Breast-Conserving Surgery in an Ethnic Minority Population: Patient Reported Outcomes Using BREAST-Q
63 Intraoperative Radiation and External Beam Radiation After Breast-Conserving Surgery in an Ethnic Minority Population: Patient Reported Outcomes Using BREAST-Q
64 A Prospective Study to Accurately Define the Nipple-Ward Margins in Patients Undergoing Lumpectomy for Breast Cancer
64 A Prospective Study to Accurately Define the Nipple-Ward Margins in Patients Undergoing Lumpectomy for Breast Cancer
65 The Outcomes of Nipple Sparing Goldilocks Mastectomy in a Primarily Overweight and Obese Population
65 The Outcomes of Nipple Sparing Goldilocks Mastectomy in a Primarily Overweight and Obese Population
67 Confocal Laser Scanning Microscopy (CLSM) for Intraoperative Histopathological Margin Assessment in Breast Conservation Surgery
67 Confocal Laser Scanning Microscopy (CLSM) for Intraoperative Histopathological Margin Assessment in Breast Conservation Surgery
68 Upper Extremity Disability Assessment Following Breast Cancer Surgery Using QuickDASH in an Ethnic Minority Population
68 Upper Extremity Disability Assessment Following Breast Cancer Surgery Using QuickDASH in an Ethnic Minority Population
70 Malignancy Upgrade Rates of Discordant Breast Lesions
70 Malignancy Upgrade Rates of Discordant Breast Lesions
71 Beyond the Surface: Suspicious Nipple Lesions
71 Beyond the Surface: Suspicious Nipple Lesions
72 Breast Cancer After Breast Augmentation: A Multicenter Collaborative Study Of Patient Management and Outcomes
72 Breast Cancer After Breast Augmentation: A Multicenter Collaborative Study Of Patient Management and Outcomes
73 Short- and Long-Term Outcomes in Use of Titanium-Coated Polypropylene Meshes in Immediate Breast Reconstruction: A Cost-Effective and Safe Option?
73 Short- and Long-Term Outcomes in Use of Titanium-Coated Polypropylene Meshes in Immediate Breast Reconstruction: A Cost-Effective and Safe Option?
74 Lessons Learned From a Breast Surgery ERAS Program in an Oncologic Ambulatory Center
74 Lessons Learned From a Breast Surgery ERAS Program in an Oncologic Ambulatory Center

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