Implementation of enhanced recovery after surgery in breast reconstruction: Lessons from a French tertiary center

Enhanced Recovery After Surgery (ERAS) programs have significantly improved postoperative outcomes across various surgical disciplines. In April 2022, an ERAS protocol tailored for patients undergoing DIEP free flap breast reconstruction was implemented at the Bordeaux Cancer Center, France. This study aimed to assess the impact of this protocol on length of stay (LOS), complication rates, and compliance with protocol items.

A retrospective pre-post observational study was conducted, including 56 consecutive patients who underwent DIEP flap reconstruction at the Bergonié Institute between September 2020 and April 2023. Twenty-eight patients received conventional perioperative care, while 28 patients were managed under the ERAS protocol. Outcomes assessed included LOS, early and 90-day postoperative complications, and adherence to the protocol's 20 key items.

Median LOS was comparable between groups, at 4.5 days pre-ERAS and 5 days post-ERAS (p = 0.52). Early and 90-day complication rates showed no significant differences. The average compliance with protocol items was 14.2 out of 20 per patient, with 35 % of recommendations followed in less than 66 % of cases.

The initial evaluation of the ERAS program showed no significant reduction in LOS or morbidity, primarily due to suboptimal adherence. These findings highlight the importance of optimizing compliance with protocol recommendations to further improve recovery outcomes, reduce LOS and potentially lower overall healthcare costs.