Abstract
Purpose
Design
Methods
Findings
Conclusions
Keywords
Data and Methods
Literature Retrieval Strategy
- Dicenso A
- Bayley L
- Haynes RB
- et al.
Inclusion and Exclusion Criteria
Criteria Used to Evaluate the Quality
- Peters M
- Godfrey C
- Mcinerney P
- et al.
- Peters M
- Godfrey C
- Mcinerney P
- et al.
Quality Evaluation Procedures for Studies
Findings
General Characteristics of the Included Literature
Menaka Pai, James D Douketis. Prevention of venous thromboembolic disease in adult nonorthopedic surgical patients. Accessed December 15, 2020.https://www.uptodate.cn/contents/prevention-of-venous-thromboembolic-disease-in-adult-nonorthopedic-surgical-patients?search=Prevention%20of%20venous%20thromboembolic%20disease%20in%20adult%20nonorthopedic%20surgical%20patients&source=search_result&selectedTitle=1∼150&display_rank=1.
Daniel Sessler. Perioperative temperature management. Accessed December 15, 2020.https://www.uptodate.cn/contents/delayed-emergence-and-emergence-delirium-in-adults?search=Perioperative%20temperature%20management&source=search_result&selectedTitle=2∼150&display_rank=2.
Nadia A Khan, William A Ghali, Enrico Cagliero. Perioperative management of blood glucose in adults with diabetes mellitus. Accessed December 15, 2020.https://www.uptodate.cn/contents/perioperative-management-of-blood-glucose-in-adults-with-diabetes-mellitus?search=Perioperative%20management%20of%20blood%20glucose%20in%20adults%20with%20diabetes%20mellitus&source=search_result&selectedTitle=1∼150&display_rank=1.
Girish P Joshi. Anesthetic management for enhanced recovery after major surgery (ERAS) in adults. Accessed December 15, 2020.https://www.uptodate.cn/contents/anesthetic-management-for-enhanced-recovery-after-major-noncardiac-surgery-eras?search=Anesthetic%20management%20for%20enhanced%20recovery%20after%20major%20surgery%20(ERAS)%20in%20adults&source=search_result&selectedTitle=1∼150&display_rank=1.
Kenneth A Bauer. Risk and prevention of venous thromboembolism in adults with cancer. Accessed December 15, 2020.https://www.uptodate.cn/contents/risk-and-prevention-of-venous-thromboembolism-in-adults-with-cancer?search=Risk%20and%20prevention%20of%20venous%20thromboembolism%20in%20adults%20with%20cancer&source=search_result&selectedTitle=1∼150&display_rank=1#H10.
Kenneth A Bauer, Gregory YH Lip Overview of the causes of venous thrombosis. Accessed December 15, 2020.https://www.uptodate.cn/contents/overview-of-the-causes-of-venous-thrombosis?search=Overview%20of%20the%20causes%20of%20venous%20thrombosis&source=search_result&selectedTitle=1∼150&display_rank=1.
Jessica Feinleib, Lori H, Kwan Ammar Yamani. Postoperative nausea and vomiting. Accessed December 15, 2020.https://www.uptodate.cn/contents/postoperative-nausea-and-vomiting?search=Postoperative%20nausea%20and%20vomiting&source=search_result&selectedTitle=1∼102&display_rank=1.
Deverick J Anderson, Daniel J Sexton.Antimicrobial prophylaxis for prevention of surgical site infection in adults. Accessed December 15, 2020.https://www.uptodate.cn/contents/antimicrobial-prophylaxis-for-prevention-of-surgical-site-infection-in-adults?search=Antimicrobial%20prophylaxis%20for%20prevention%20of%20surgical%20site%20infection%20in%20adults&source=search_result&selectedTitle=1∼150&display_rank=1.
Edward R Mariano. Management of acute perioperative pain. Accessed December 15, 2020.https://www.uptodate.cn/contents/management-of-acute-perioperative-pain-in-adults?search=Management%20of%20acute%20perioperative%20pain&source=search_result&selectedTitle=1∼150&display_rank=1.
Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures an updated report by the American society of anesthesiologists task force on preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration.
- Offodile AC
- Gu C
- Boukovalas S
- et al.
- Sebai ME
- Siotos C
- Payne R
- et al.
after surgery pathway for microsurgical breast reconstruction: a systematic review and meta-analysis.
- Stone JP
- Siotos C
- Sarmiento S
- et al.
Menaka Pai, James D Douketis. Prevention of venous thromboembolic disease in adult nonorthopedic surgical patients. Accessed December 15, 2020.https://www.uptodate.cn/contents/prevention-of-venous-thromboembolic-disease-in-adult-nonorthopedic-surgical-patients?search=Prevention%20of%20venous%20thromboembolic%20disease%20in%20adult%20nonorthopedic%20surgical%20patients&source=search_result&selectedTitle=1∼150&display_rank=1.
Daniel Sessler. Perioperative temperature management. Accessed December 15, 2020.https://www.uptodate.cn/contents/delayed-emergence-and-emergence-delirium-in-adults?search=Perioperative%20temperature%20management&source=search_result&selectedTitle=2∼150&display_rank=2.
Nadia A Khan, William A Ghali, Enrico Cagliero. Perioperative management of blood glucose in adults with diabetes mellitus. Accessed December 15, 2020.https://www.uptodate.cn/contents/perioperative-management-of-blood-glucose-in-adults-with-diabetes-mellitus?search=Perioperative%20management%20of%20blood%20glucose%20in%20adults%20with%20diabetes%20mellitus&source=search_result&selectedTitle=1∼150&display_rank=1.
Girish P Joshi. Anesthetic management for enhanced recovery after major surgery (ERAS) in adults. Accessed December 15, 2020.https://www.uptodate.cn/contents/anesthetic-management-for-enhanced-recovery-after-major-noncardiac-surgery-eras?search=Anesthetic%20management%20for%20enhanced%20recovery%20after%20major%20surgery%20(ERAS)%20in%20adults&source=search_result&selectedTitle=1∼150&display_rank=1.
Kenneth A Bauer. Risk and prevention of venous thromboembolism in adults with cancer. Accessed December 15, 2020.https://www.uptodate.cn/contents/risk-and-prevention-of-venous-thromboembolism-in-adults-with-cancer?search=Risk%20and%20prevention%20of%20venous%20thromboembolism%20in%20adults%20with%20cancer&source=search_result&selectedTitle=1∼150&display_rank=1#H10.
Kenneth A Bauer, Gregory YH Lip Overview of the causes of venous thrombosis. Accessed December 15, 2020.https://www.uptodate.cn/contents/overview-of-the-causes-of-venous-thrombosis?search=Overview%20of%20the%20causes%20of%20venous%20thrombosis&source=search_result&selectedTitle=1∼150&display_rank=1.
Jessica Feinleib, Lori H, Kwan Ammar Yamani. Postoperative nausea and vomiting. Accessed December 15, 2020.https://www.uptodate.cn/contents/postoperative-nausea-and-vomiting?search=Postoperative%20nausea%20and%20vomiting&source=search_result&selectedTitle=1∼102&display_rank=1.
Deverick J Anderson, Daniel J Sexton.Antimicrobial prophylaxis for prevention of surgical site infection in adults. Accessed December 15, 2020.https://www.uptodate.cn/contents/antimicrobial-prophylaxis-for-prevention-of-surgical-site-infection-in-adults?search=Antimicrobial%20prophylaxis%20for%20prevention%20of%20surgical%20site%20infection%20in%20adults&source=search_result&selectedTitle=1∼150&display_rank=1.
Edward R Mariano. Management of acute perioperative pain. Accessed December 15, 2020.https://www.uptodate.cn/contents/management-of-acute-perioperative-pain-in-adults?search=Management%20of%20acute%20perioperative%20pain&source=search_result&selectedTitle=1∼150&display_rank=1.
- Offodile AC
- Gu C
- Boukovalas S
- et al.
- Sebai ME
- Siotos C
- Payne R
- et al.
after surgery pathway for microsurgical breast reconstruction: a systematic review and meta-analysis.
Edward R Mariano. Management of acute perioperative pain. Accessed December 15, 2020.https://www.uptodate.cn/contents/management-of-acute-perioperative-pain-in-adults?search=Management%20of%20acute%20perioperative%20pain&source=search_result&selectedTitle=1∼150&display_rank=1.
- Stone JP
- Siotos C
- Sarmiento S
- et al.
Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures an updated report by the American society of anesthesiologists task force on preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration.
| Authors | Year | Database Source | Document Type | Topic |
|---|---|---|---|---|
| CARSE Group 10 | 2016 | Global | Expert consensus | Perioperative management of accelerated rehabilitation surgery in China |
| Chinese Medical Association Surgery Branch, Chinese Medical Association Anesthesiology Branch 11 | 2018 | China Guide Network | Guideline | Chinese expert consensus and path management guide for accelerated rehabilitation surgery |
| EEN Branch of Chinese Medical Association 12 | 2019 | Global | Expert consensus | Chinese expert consensus on accelerating perioperative nutritional support in rehabilitation surgery |
| Menaka et al 13 Menaka Pai, James D Douketis. Prevention of venous thromboembolic disease in adult nonorthopedic surgical patients. Accessed December 15, 2020.https://www.uptodate.cn/contents/prevention-of-venous-thromboembolic-disease-in-adult-nonorthopedic-surgical-patients?search=Prevention%20of%20venous%20thromboembolic%20disease%20in%20adult%20nonorthopedic%20surgical%20patients&source=search_result&selectedTitle=1∼150&display_rank=1. | 2019 | Up to Date | Clinical decision-making | Prevention of venous thromboembolic diseases in adult patients undergoing nonorthopedic surgery |
| Daniel et al 14 Daniel Sessler. Perioperative temperature management. Accessed December 15, 2020.https://www.uptodate.cn/contents/delayed-emergence-and-emergence-delirium-in-adults?search=Perioperative%20temperature%20management&source=search_result&selectedTitle=2∼150&display_rank=2. | 2019 | Up to Date | Clinical decision-making | Perioperative temperature management |
| Nadia et al 15 Nadia A Khan, William A Ghali, Enrico Cagliero. Perioperative management of blood glucose in adults with diabetes mellitus. Accessed December 15, 2020.https://www.uptodate.cn/contents/perioperative-management-of-blood-glucose-in-adults-with-diabetes-mellitus?search=Perioperative%20management%20of%20blood%20glucose%20in%20adults%20with%20diabetes%20mellitus&source=search_result&selectedTitle=1∼150&display_rank=1. | 2018 | Up to Date | Clinical decision-making | Perioperative blood glucose management of adult diabetic patients |
| Girish et al 16 Girish P Joshi. Anesthetic management for enhanced recovery after major surgery (ERAS) in adults. Accessed December 15, 2020.https://www.uptodate.cn/contents/anesthetic-management-for-enhanced-recovery-after-major-noncardiac-surgery-eras?search=Anesthetic%20management%20for%20enhanced%20recovery%20after%20major%20surgery%20(ERAS)%20in%20adults&source=search_result&selectedTitle=1∼150&display_rank=1. | 2019 | Up to Date | Clinical decision-making | Anesthesia management and the improvement of recovery after significant adult surgery (ERAS) |
| Kenneth et al 17 Kenneth A Bauer. Risk and prevention of venous thromboembolism in adults with cancer. Accessed December 15, 2020.https://www.uptodate.cn/contents/risk-and-prevention-of-venous-thromboembolism-in-adults-with-cancer?search=Risk%20and%20prevention%20of%20venous%20thromboembolism%20in%20adults%20with%20cancer&source=search_result&selectedTitle=1∼150&display_rank=1#H10. | 2019 | Up to Date | Clinical decisionmaking | Risk and prevention of venous thromboembolism in adult cancer patients |
| Gregory et al 18 Kenneth A Bauer, Gregory YH Lip Overview of the causes of venous thrombosis. Accessed December 15, 2020.https://www.uptodate.cn/contents/overview-of-the-causes-of-venous-thrombosis?search=Overview%20of%20the%20causes%20of%20venous%20thrombosis&source=search_result&selectedTitle=1∼150&display_rank=1. | 2019 | Up to Date | Clinical decision-making | Summary of the causes of venous thrombosis |
| Jessica et al 19 Jessica Feinleib, Lori H, Kwan Ammar Yamani. Postoperative nausea and vomiting. Accessed December 15, 2020.https://www.uptodate.cn/contents/postoperative-nausea-and-vomiting?search=Postoperative%20nausea%20and%20vomiting&source=search_result&selectedTitle=1∼102&display_rank=1. | 2019 | Up to Date | Clinical decision-making | Prevention and treatment of postoperative nausea and vomiting |
| Deverick et al 20 Deverick J Anderson, Daniel J Sexton.Antimicrobial prophylaxis for prevention of surgical site infection in adults. Accessed December 15, 2020.https://www.uptodate.cn/contents/antimicrobial-prophylaxis-for-prevention-of-surgical-site-infection-in-adults?search=Antimicrobial%20prophylaxis%20for%20prevention%20of%20surgical%20site%20infection%20in%20adults&source=search_result&selectedTitle=1∼150&display_rank=1. | 2019 | Up to Date | Clinical decision-making | Antibiotic prevention of surgical site infection in adults |
| Edward et al 21 Edward R Mariano. Management of acute perioperative pain. Accessed December 15, 2020.https://www.uptodate.cn/contents/management-of-acute-perioperative-pain-in-adults?search=Management%20of%20acute%20perioperative%20pain&source=search_result&selectedTitle=1∼150&display_rank=1. | 2019 | Up to Date | Clinical decision-making | Management of acute perioperative pain |
| International ERAS Association 22 | 2017 | PubMed | Expert consensus | Consensus evaluation of the best perioperative nursing care in breast reconstruction: social suggestions for postoperative recovery period (ERAS) |
| American Association of Anesthesiologists 23 American Society of Anesthesiologists Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures an updated report by the American society of anesthesiologists task force on preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration. | 2017 | NICE | guideline | Preoperative fasting guidelines |
| Lau et al 24 | 2016 | PubMed | System evaluation | Influence of accelerated rehabilitation program on treatment effect and rehabilitation ability of patients |
| Offodile et al 25
Enhanced recovery after surgery (ERAS) pathways in breast reconstruction: systematic review and meta-analysis of the literature. Breast Cancer Res Treat. 2019; https://doi.org/10.1007/s10549-018-4991-8 | 2019 | PubMed | System evaluation | Safety and effectiveness of ERAS approach in breast reconstruction |
| Mohamad et al 26
Enhanced recovery after surgery pathway for microsurgical breast reconstruction: a systematic review and meta-analysis. Plast Reconstr Surg. 2018; https://doi.org/10.1097/PRS.0000000000005300 | 2018 | PubMed | System evaluation | Effect of ERAS on hospital stay and postoperative complications in breast reconstruction |
| Johns Hopkins University Microsurgical Breast Reconstruction Team 27
Implementing our microsurgical breast reconstruction enhanced recovery after surgery pathway: consensus obstacles and recommendations. Plast Reconstr Surg Glob Open. 2019; 7https://doi.org/10.1097/GOX.0000000000001855 | 2018 | PubMed | Expert consensus | Expert consensus on perioperative ERAS program for breast reconstruction |
| Soteropulos et al 28 | 2019 | PubMed | System evaluation | Safety of ERAS approach in breast reconstruction |
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Evaluation of the Quality of the Included Literature
- Offodile AC
- Gu C
- Boukovalas S
- et al.
- Sebai ME
- Siotos C
- Payne R
- et al.
after surgery pathway for microsurgical breast reconstruction: a systematic review and meta-analysis.
- Stone JP
- Siotos C
- Sarmiento S
- et al.
Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures an updated report by the American society of anesthesiologists task force on preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration.
| Evaluation Item | Lau et al 24 | Offodile et al 25
Enhanced recovery after surgery (ERAS) pathways in breast reconstruction: systematic review and meta-analysis of the literature. Breast Cancer Res Treat. 2019; https://doi.org/10.1007/s10549-018-4991-8 | Mohamad et al 26
Enhanced recovery after surgery pathway for microsurgical breast reconstruction: a systematic review and meta-analysis. Plast Reconstr Surg. 2018; https://doi.org/10.1097/PRS.0000000000005300 | Soteropulos et al 28 |
|---|---|---|---|---|
| 1. Is the evidence-based question clear and definite? | Yes | Yes | Yes | Yes |
| 2. Is the standard of literature inclusion appropriate for this evidence-based problem? | Yes | Yes | Yes | Yes |
| 3. Is the retrieval strategy appropriate? | Yes | Yes | Yes | Yes |
| 4. Is the database or resources for searching literature sufficient? | Yes | Yes | Yes | Yes |
| 5. Is the literature quality evaluation standard adopted appropriate? | Unclear | Yes | Yes | Unclear |
| 6. Whether two or more evaluators independently complete the literature quality evaluation? | Unclear | Yes | Yes | Yes |
| 7. Are certain measures taken to reduce errors when extracting data? | Unclear | Yes | Yes | Unclear |
| 8. Is the method of combined research appropriate? | Yes | Yes | Yes | Yes |
| 9. Has the possibility of publication bias been assessed? | Yes | Yes | Yes | No |
| 10. Is the proposed policy or practice recommendation based on the results of the systematic evaluation? | Yes | Yes | Yes | Yes |
| 11. Is the proposed further research direction appropriate? | Yes | Yes | Yes | Yes |
| Evaluation Item | Branch of Parenteral and Enteral Nutrition of Chinese Medical Association 11 | International ERAS Association 22 | Microsurgical Breast Reconstruction Team at Johns Hopkins University 27
Implementing our microsurgical breast reconstruction enhanced recovery after surgery pathway: consensus obstacles and recommendations. Plast Reconstr Surg Glob Open. 2019; 7https://doi.org/10.1097/GOX.0000000000001855 | Expert Group of China Accelerated Rehabilitation Surgery 10 |
|---|---|---|---|---|
| 1. Are the sources of opinions marked? | Unclear | Yes | Yes | Unclear |
| 2. Does the opinion come from influential experts in this field? | Yes | Yes | Yes | Yes |
| 3. Does the viewpoint put forward focus on the interests of the people concerned? | Yes | Yes | Yes | Yes |
| 4. Are the stated conclusions based on the results of analysis? Is the expression of views logical? | Yes | Yes | Yes | Yes |
| 5. Have you consulted other existing literatures? | Yes | Yes | Yes | Yes |
| 6. Are there any inconsistencies between the views put forward and the previous literature? | Yes | Yes | Yes | Yes |
| Information Imported | Standardization Percentage for Each Field (%) | Mean Overall Score (points) | ≥60% of Fields | ≥30% of Fields | Recommended Level | Recommended? | |||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Scope and purpose | Participate in person | Rigidity of formulation | Clarity | Applicability | Independence | ||||||
| Chinese Medical Association Surgery Branch, Chinese Medical Association Anesthesiology Branch 11 | 84.35 | 50.25 | 42.67 | 89.75 | 52.38 | 24.35 | 4.5 | 1 | 5 | B | Yes |
| American Association of Anesthesiologists 23 American Society of Anesthesiologists Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures an updated report by the American society of anesthesiologists task force on preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration. | 100 | 85.79 | 79.8 | 94.56 | 86.49 | 94.34 | 7.0 | 6 | 6 | A | Yes |
Summary of Studies
- Stone JP
- Siotos C
- Sarmiento S
- et al.
Girish P Joshi. Anesthetic management for enhanced recovery after major surgery (ERAS) in adults. Accessed December 15, 2020.https://www.uptodate.cn/contents/anesthetic-management-for-enhanced-recovery-after-major-noncardiac-surgery-eras?search=Anesthetic%20management%20for%20enhanced%20recovery%20after%20major%20surgery%20(ERAS)%20in%20adults&source=search_result&selectedTitle=1∼150&display_rank=1.
- Stone JP
- Siotos C
- Sarmiento S
- et al.
Menaka Pai, James D Douketis. Prevention of venous thromboembolic disease in adult nonorthopedic surgical patients. Accessed December 15, 2020.https://www.uptodate.cn/contents/prevention-of-venous-thromboembolic-disease-in-adult-nonorthopedic-surgical-patients?search=Prevention%20of%20venous%20thromboembolic%20disease%20in%20adult%20nonorthopedic%20surgical%20patients&source=search_result&selectedTitle=1∼150&display_rank=1.
Kenneth A Bauer. Risk and prevention of venous thromboembolism in adults with cancer. Accessed December 15, 2020.https://www.uptodate.cn/contents/risk-and-prevention-of-venous-thromboembolism-in-adults-with-cancer?search=Risk%20and%20prevention%20of%20venous%20thromboembolism%20in%20adults%20with%20cancer&source=search_result&selectedTitle=1∼150&display_rank=1#H10.
Kenneth A Bauer, Gregory YH Lip Overview of the causes of venous thrombosis. Accessed December 15, 2020.https://www.uptodate.cn/contents/overview-of-the-causes-of-venous-thrombosis?search=Overview%20of%20the%20causes%20of%20venous%20thrombosis&source=search_result&selectedTitle=1∼150&display_rank=1.
- Stone JP
- Siotos C
- Sarmiento S
- et al.
Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures an updated report by the American society of anesthesiologists task force on preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration.
- Sebai ME
- Siotos C
- Payne R
- et al.
after surgery pathway for microsurgical breast reconstruction: a systematic review and meta-analysis.
- Stone JP
- Siotos C
- Sarmiento S
- et al.
Deverick J Anderson, Daniel J Sexton.Antimicrobial prophylaxis for prevention of surgical site infection in adults. Accessed December 15, 2020.https://www.uptodate.cn/contents/antimicrobial-prophylaxis-for-prevention-of-surgical-site-infection-in-adults?search=Antimicrobial%20prophylaxis%20for%20prevention%20of%20surgical%20site%20infection%20in%20adults&source=search_result&selectedTitle=1∼150&display_rank=1.
Deverick J Anderson, Daniel J Sexton.Antimicrobial prophylaxis for prevention of surgical site infection in adults. Accessed December 15, 2020.https://www.uptodate.cn/contents/antimicrobial-prophylaxis-for-prevention-of-surgical-site-infection-in-adults?search=Antimicrobial%20prophylaxis%20for%20prevention%20of%20surgical%20site%20infection%20in%20adults&source=search_result&selectedTitle=1∼150&display_rank=1.
- Stone JP
- Siotos C
- Sarmiento S
- et al.
Nadia A Khan, William A Ghali, Enrico Cagliero. Perioperative management of blood glucose in adults with diabetes mellitus. Accessed December 15, 2020.https://www.uptodate.cn/contents/perioperative-management-of-blood-glucose-in-adults-with-diabetes-mellitus?search=Perioperative%20management%20of%20blood%20glucose%20in%20adults%20with%20diabetes%20mellitus&source=search_result&selectedTitle=1∼150&display_rank=1.
Girish P Joshi. Anesthetic management for enhanced recovery after major surgery (ERAS) in adults. Accessed December 15, 2020.https://www.uptodate.cn/contents/anesthetic-management-for-enhanced-recovery-after-major-noncardiac-surgery-eras?search=Anesthetic%20management%20for%20enhanced%20recovery%20after%20major%20surgery%20(ERAS)%20in%20adults&source=search_result&selectedTitle=1∼150&display_rank=1.
- Offodile AC
- Gu C
- Boukovalas S
- et al.
- Stone JP
- Siotos C
- Sarmiento S
- et al.
Jessica Feinleib, Lori H, Kwan Ammar Yamani. Postoperative nausea and vomiting. Accessed December 15, 2020.https://www.uptodate.cn/contents/postoperative-nausea-and-vomiting?search=Postoperative%20nausea%20and%20vomiting&source=search_result&selectedTitle=1∼102&display_rank=1.
- Stone JP
- Siotos C
- Sarmiento S
- et al.
Edward R Mariano. Management of acute perioperative pain. Accessed December 15, 2020.https://www.uptodate.cn/contents/management-of-acute-perioperative-pain-in-adults?search=Management%20of%20acute%20perioperative%20pain&source=search_result&selectedTitle=1∼150&display_rank=1.
- Sebai ME
- Siotos C
- Payne R
- et al.
after surgery pathway for microsurgical breast reconstruction: a systematic review and meta-analysis.
- Stone JP
- Siotos C
- Sarmiento S
- et al.
Girish P Joshi. Anesthetic management for enhanced recovery after major surgery (ERAS) in adults. Accessed December 15, 2020.https://www.uptodate.cn/contents/anesthetic-management-for-enhanced-recovery-after-major-noncardiac-surgery-eras?search=Anesthetic%20management%20for%20enhanced%20recovery%20after%20major%20surgery%20(ERAS)%20in%20adults&source=search_result&selectedTitle=1∼150&display_rank=1.
Jessica Feinleib, Lori H, Kwan Ammar Yamani. Postoperative nausea and vomiting. Accessed December 15, 2020.https://www.uptodate.cn/contents/postoperative-nausea-and-vomiting?search=Postoperative%20nausea%20and%20vomiting&source=search_result&selectedTitle=1∼102&display_rank=1.
- Offodile AC
- Gu C
- Boukovalas S
- et al.
- Stone JP
- Siotos C
- Sarmiento S
- et al.
Daniel Sessler. Perioperative temperature management. Accessed December 15, 2020.https://www.uptodate.cn/contents/delayed-emergence-and-emergence-delirium-in-adults?search=Perioperative%20temperature%20management&source=search_result&selectedTitle=2∼150&display_rank=2.
Girish P Joshi. Anesthetic management for enhanced recovery after major surgery (ERAS) in adults. Accessed December 15, 2020.https://www.uptodate.cn/contents/anesthetic-management-for-enhanced-recovery-after-major-noncardiac-surgery-eras?search=Anesthetic%20management%20for%20enhanced%20recovery%20after%20major%20surgery%20(ERAS)%20in%20adults&source=search_result&selectedTitle=1∼150&display_rank=1.
- Stone JP
- Siotos C
- Sarmiento S
- et al.
Menaka Pai, James D Douketis. Prevention of venous thromboembolic disease in adult nonorthopedic surgical patients. Accessed December 15, 2020.https://www.uptodate.cn/contents/prevention-of-venous-thromboembolic-disease-in-adult-nonorthopedic-surgical-patients?search=Prevention%20of%20venous%20thromboembolic%20disease%20in%20adult%20nonorthopedic%20surgical%20patients&source=search_result&selectedTitle=1∼150&display_rank=1.
Kenneth A Bauer. Risk and prevention of venous thromboembolism in adults with cancer. Accessed December 15, 2020.https://www.uptodate.cn/contents/risk-and-prevention-of-venous-thromboembolism-in-adults-with-cancer?search=Risk%20and%20prevention%20of%20venous%20thromboembolism%20in%20adults%20with%20cancer&source=search_result&selectedTitle=1∼150&display_rank=1#H10.
- Stone JP
- Siotos C
- Sarmiento S
- et al.
- Offodile AC
- Gu C
- Boukovalas S
- et al.
- Stone JP
- Siotos C
- Sarmiento S
- et al.
Deverick J Anderson, Daniel J Sexton.Antimicrobial prophylaxis for prevention of surgical site infection in adults. Accessed December 15, 2020.https://www.uptodate.cn/contents/antimicrobial-prophylaxis-for-prevention-of-surgical-site-infection-in-adults?search=Antimicrobial%20prophylaxis%20for%20prevention%20of%20surgical%20site%20infection%20in%20adults&source=search_result&selectedTitle=1∼150&display_rank=1.
- Stone JP
- Siotos C
- Sarmiento S
- et al.
- Stone JP
- Siotos C
- Sarmiento S
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| Classification | Protocol Details [References] | Level of Evidence | Recommendation Level |
|---|---|---|---|
| Preoperative education | •Patients should receive detailed preoperative consultation. 10 , 11 , 22 , 27
Implementing our microsurgical breast reconstruction enhanced recovery after surgery pathway: consensus obstacles and recommendations. Plast Reconstr Surg Glob Open. 2019; 7https://doi.org/10.1097/GOX.0000000000001855 | 2 | A |
| •Psychological support should be provided to patients before surgery. 10 , 27
Implementing our microsurgical breast reconstruction enhanced recovery after surgery pathway: consensus obstacles and recommendations. Plast Reconstr Surg Glob Open. 2019; 7https://doi.org/10.1097/GOX.0000000000001855 | 5 | A | |
| Preoperative visit and evaluation | •The nutritional status, cardiopulmonary function, and underlying diseases should be comprehensively screened before surgery by multidisciplinary consultation; corrective and targeted treatment should be carried out. Patients should be adjusted to the best state before surgery and carefully evaluated for surgical indications, anesthesia, operative risks and tolerance. Corresponding plans should be formulated for associated diseases and possible complications. 10 ,11 ,12 ,16 ,Girish P Joshi. Anesthetic management for enhanced recovery after major surgery (ERAS) in adults. Accessed December 15, 2020.https://www.uptodate.cn/contents/anesthetic-management-for-enhanced-recovery-after-major-noncardiac-surgery-eras?search=Anesthetic%20management%20for%20enhanced%20recovery%20after%20major%20surgery%20(ERAS)%20in%20adults&source=search_result&selectedTitle=1∼150&display_rank=1. 24 | 1 | A |
| Preoperative smoking and alcohol withdrawal | •Patients with a history of drinking or smoking should give up drinking for 4 wk, and smoking for at least 2 wk, before surgery. 10 ,11 ,22 ,27 Obese patients should be encouraged to lose weight before surgery.
Implementing our microsurgical breast reconstruction enhanced recovery after surgery pathway: consensus obstacles and recommendations. Plast Reconstr Surg Glob Open. 2019; 7https://doi.org/10.1097/GOX.0000000000001855 22 , 27
Implementing our microsurgical breast reconstruction enhanced recovery after surgery pathway: consensus obstacles and recommendations. Plast Reconstr Surg Glob Open. 2019; 7https://doi.org/10.1097/GOX.0000000000001855 | 5 | A |
| Preoperative prevention of venous thrombosis | •The improved Caprini risk assessment model should be used to assess the risk of postoperative VTE in patients before surgery. In the absence of thrombosis prevention, patients receiving surgical treatment should be graded according to the estimated VTE baseline risk (EBR) so as to select appropriate VTE prevention methods and receive education on the risk of VTE. 10 ,13 ,Menaka Pai, James D Douketis. Prevention of venous thromboembolic disease in adult nonorthopedic surgical patients. Accessed December 15, 2020.https://www.uptodate.cn/contents/prevention-of-venous-thromboembolic-disease-in-adult-nonorthopedic-surgical-patients?search=Prevention%20of%20venous%20thromboembolic%20disease%20in%20adult%20nonorthopedic%20surgical%20patients&source=search_result&selectedTitle=1∼150&display_rank=1. 17 ,Kenneth A Bauer. Risk and prevention of venous thromboembolism in adults with cancer. Accessed December 15, 2020.https://www.uptodate.cn/contents/risk-and-prevention-of-venous-thromboembolism-in-adults-with-cancer?search=Risk%20and%20prevention%20of%20venous%20thromboembolism%20in%20adults%20with%20cancer&source=search_result&selectedTitle=1∼150&display_rank=1#H10. 18 ,Kenneth A Bauer, Gregory YH Lip Overview of the causes of venous thrombosis. Accessed December 15, 2020.https://www.uptodate.cn/contents/overview-of-the-causes-of-venous-thrombosis?search=Overview%20of%20the%20causes%20of%20venous%20thrombosis&source=search_result&selectedTitle=1∼150&display_rank=1. 22 ,27
Implementing our microsurgical breast reconstruction enhanced recovery after surgery pathway: consensus obstacles and recommendations. Plast Reconstr Surg Glob Open. 2019; 7https://doi.org/10.1097/GOX.0000000000001855 | 1 | A |
| •The main measures to prevent VTE include early activities, drug treatment, and mechanical methods. Individual VTE prevention strategies should be formulated according to the risk of VTE and the risk and consequences of massive hemorrhage. 13 ,Menaka Pai, James D Douketis. Prevention of venous thromboembolic disease in adult nonorthopedic surgical patients. Accessed December 15, 2020.https://www.uptodate.cn/contents/prevention-of-venous-thromboembolic-disease-in-adult-nonorthopedic-surgical-patients?search=Prevention%20of%20venous%20thromboembolic%20disease%20in%20adult%20nonorthopedic%20surgical%20patients&source=search_result&selectedTitle=1∼150&display_rank=1. 17 Kenneth A Bauer. Risk and prevention of venous thromboembolism in adults with cancer. Accessed December 15, 2020.https://www.uptodate.cn/contents/risk-and-prevention-of-venous-thromboembolism-in-adults-with-cancer?search=Risk%20and%20prevention%20of%20venous%20thromboembolism%20in%20adults%20with%20cancer&source=search_result&selectedTitle=1∼150&display_rank=1#H10. | 1 | A | |
| •Mechanical methods for preventing thrombosis include intermittent pneumatic compression (IPC), graded compression stockings (GCS), and venous foot pump (VFP). 13 , Menaka Pai, James D Douketis. Prevention of venous thromboembolic disease in adult nonorthopedic surgical patients. Accessed December 15, 2020.https://www.uptodate.cn/contents/prevention-of-venous-thromboembolic-disease-in-adult-nonorthopedic-surgical-patients?search=Prevention%20of%20venous%20thromboembolic%20disease%20in%20adult%20nonorthopedic%20surgical%20patients&source=search_result&selectedTitle=1∼150&display_rank=1. 17 , Kenneth A Bauer. Risk and prevention of venous thromboembolism in adults with cancer. Accessed December 15, 2020.https://www.uptodate.cn/contents/risk-and-prevention-of-venous-thromboembolism-in-adults-with-cancer?search=Risk%20and%20prevention%20of%20venous%20thromboembolism%20in%20adults%20with%20cancer&source=search_result&selectedTitle=1∼150&display_rank=1#H10. 18 Kenneth A Bauer, Gregory YH Lip Overview of the causes of venous thrombosis. Accessed December 15, 2020.https://www.uptodate.cn/contents/overview-of-the-causes-of-venous-thrombosis?search=Overview%20of%20the%20causes%20of%20venous%20thrombosis&source=search_result&selectedTitle=1∼150&display_rank=1. | 1 | A | |
| •The use of mechanical methods to prevent thrombosis should begin before or in the operating room and continue until discharge. 13 , Menaka Pai, James D Douketis. Prevention of venous thromboembolic disease in adult nonorthopedic surgical patients. Accessed December 15, 2020.https://www.uptodate.cn/contents/prevention-of-venous-thromboembolic-disease-in-adult-nonorthopedic-surgical-patients?search=Prevention%20of%20venous%20thromboembolic%20disease%20in%20adult%20nonorthopedic%20surgical%20patients&source=search_result&selectedTitle=1∼150&display_rank=1. 17 Kenneth A Bauer. Risk and prevention of venous thromboembolism in adults with cancer. Accessed December 15, 2020.https://www.uptodate.cn/contents/risk-and-prevention-of-venous-thromboembolism-in-adults-with-cancer?search=Risk%20and%20prevention%20of%20venous%20thromboembolism%20in%20adults%20with%20cancer&source=search_result&selectedTitle=1∼150&display_rank=1#H10. | 2 | A | |
| •Low molecular weight (LMW) heparin is usually the preferred anticoagulant. 17 Kenneth A Bauer. Risk and prevention of venous thromboembolism in adults with cancer. Accessed December 15, 2020.https://www.uptodate.cn/contents/risk-and-prevention-of-venous-thromboembolism-in-adults-with-cancer?search=Risk%20and%20prevention%20of%20venous%20thromboembolism%20in%20adults%20with%20cancer&source=search_result&selectedTitle=1∼150&display_rank=1#H10. | 2 | A | |
| •Thrombosis screening using ultrasound and inferior vena cava filters is not recommended. 13 ,Menaka Pai, James D Douketis. Prevention of venous thromboembolic disease in adult nonorthopedic surgical patients. Accessed December 15, 2020.https://www.uptodate.cn/contents/prevention-of-venous-thromboembolic-disease-in-adult-nonorthopedic-surgical-patients?search=Prevention%20of%20venous%20thromboembolic%20disease%20in%20adult%20nonorthopedic%20surgical%20patients&source=search_result&selectedTitle=1∼150&display_rank=1. 17 Kenneth A Bauer. Risk and prevention of venous thromboembolism in adults with cancer. Accessed December 15, 2020.https://www.uptodate.cn/contents/risk-and-prevention-of-venous-thromboembolism-in-adults-with-cancer?search=Risk%20and%20prevention%20of%20venous%20thromboembolism%20in%20adults%20with%20cancer&source=search_result&selectedTitle=1∼150&display_rank=1#H10. | 2 | B | |
| •Prevention of postoperative VTE should avoid the use of inferior vena cava (IVC) filters. 17 Kenneth A Bauer. Risk and prevention of venous thromboembolism in adults with cancer. Accessed December 15, 2020.https://www.uptodate.cn/contents/risk-and-prevention-of-venous-thromboembolism-in-adults-with-cancer?search=Risk%20and%20prevention%20of%20venous%20thromboembolism%20in%20adults%20with%20cancer&source=search_result&selectedTitle=1∼150&display_rank=1#H10. | 2 | B | |
| Preoperative fasting | •The patients were fasted drink 2 h before surgery and foods 6 h before surgery. They can eat starchy solid foods (the gastric emptying time of dairy products such as milk was equivalent to that of solid foods) before surgery, but fried, fat, and meat foods require a longer fasting time. Carbohydrate-containing drinks can be taken orally before surgery. Patients are usually given 12.5% carbohydrate drinks (800 mL) 10 h before surgery and ≤ 400 mL 2 h before surgery. 10 ,11 ,22 ,23 ,American Society of Anesthesiologists Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures an updated report by the American society of anesthesiologists task force on preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration. 26 ,
Enhanced recovery after surgery pathway for microsurgical breast reconstruction: a systematic review and meta-analysis. Plast Reconstr Surg. 2018; https://doi.org/10.1097/PRS.0000000000005300 27
Implementing our microsurgical breast reconstruction enhanced recovery after surgery pathway: consensus obstacles and recommendations. Plast Reconstr Surg Glob Open. 2019; 7https://doi.org/10.1097/GOX.0000000000001855 | 1 | A |
| Skin preparation | •Clean the skin of the surgical area with chlorhexidine preoperatively. 20 Deverick J Anderson, Daniel J Sexton.Antimicrobial prophylaxis for prevention of surgical site infection in adults. Accessed December 15, 2020.https://www.uptodate.cn/contents/antimicrobial-prophylaxis-for-prevention-of-surgical-site-infection-in-adults?search=Antimicrobial%20prophylaxis%20for%20prevention%20of%20surgical%20site%20infection%20in%20adults&source=search_result&selectedTitle=1∼150&display_rank=1. | 2 | A |
| •Avoid shaving at planned surgical sites. If skin preparation is necessary, electric shears or a hair removal agent should be used for skin preparation in the surgical area. The skin should be prepared near to the day of surgery. 20 Deverick J Anderson, Daniel J Sexton.Antimicrobial prophylaxis for prevention of surgical site infection in adults. Accessed December 15, 2020.https://www.uptodate.cn/contents/antimicrobial-prophylaxis-for-prevention-of-surgical-site-infection-in-adults?search=Antimicrobial%20prophylaxis%20for%20prevention%20of%20surgical%20site%20infection%20in%20adults&source=search_result&selectedTitle=1∼150&display_rank=1. | 2 | A | |
| Preventive use of antibiotics | •In the absence of other risk factors for infection, no antibacterial prophylaxis is performed for clean breast surgery. These risk factors include extreme age, poor nutritional status, obesity, diabetes, smoking, co-infection, immunosuppression, corticosteroid treatment, recent surgical procedures, the length of preoperative hospitalization, and known colonization by resistant bacteria. 20 , Deverick J Anderson, Daniel J Sexton.Antimicrobial prophylaxis for prevention of surgical site infection in adults. Accessed December 15, 2020.https://www.uptodate.cn/contents/antimicrobial-prophylaxis-for-prevention-of-surgical-site-infection-in-adults?search=Antimicrobial%20prophylaxis%20for%20prevention%20of%20surgical%20site%20infection%20in%20adults&source=search_result&selectedTitle=1∼150&display_rank=1. 24 , 28 | 2 | A |
| •Patients with signs of active infection should complete appropriate treatment before surgery, especially when a prosthesis is likely to be fitted. If emergency surgery is considered, the risk of infection must be balanced according to the individual operation time. 20 Deverick J Anderson, Daniel J Sexton.Antimicrobial prophylaxis for prevention of surgical site infection in adults. Accessed December 15, 2020.https://www.uptodate.cn/contents/antimicrobial-prophylaxis-for-prevention-of-surgical-site-infection-in-adults?search=Antimicrobial%20prophylaxis%20for%20prevention%20of%20surgical%20site%20infection%20in%20adults&source=search_result&selectedTitle=1∼150&display_rank=1. | 1 | A | |
| •Cefazolin is the preferred antibiotic for prophylaxis. Patients with β-lactam allergy can use clindamycin and vancomycin. No repeated use of antibiotics after wound closure as this may increase resistance to antibiotics . 20 , Deverick J Anderson, Daniel J Sexton.Antimicrobial prophylaxis for prevention of surgical site infection in adults. Accessed December 15, 2020.https://www.uptodate.cn/contents/antimicrobial-prophylaxis-for-prevention-of-surgical-site-infection-in-adults?search=Antimicrobial%20prophylaxis%20for%20prevention%20of%20surgical%20site%20infection%20in%20adults&source=search_result&selectedTitle=1∼150&display_rank=1. 27 ,
Implementing our microsurgical breast reconstruction enhanced recovery after surgery pathway: consensus obstacles and recommendations. Plast Reconstr Surg Glob Open. 2019; 7https://doi.org/10.1097/GOX.0000000000001855 28 | 2 | A | |
| Preoperative blood glucose control | •All patients need careful preoperative medical history and physical examination; some patients need to be further evaluated. Basic laboratory tests should include baseline electrocardiogram (ECG), renal function assessment (serum creatinine), glycosylated hemoglobin, and blood glucose. Perioperative blood glucose control begins before surgery, including the provision of appropriate suggestions for diabetic patients taking hypoglycemic drugs and insulin. 10 , 11 , 15 Nadia A Khan, William A Ghali, Enrico Cagliero. Perioperative management of blood glucose in adults with diabetes mellitus. Accessed December 15, 2020.https://www.uptodate.cn/contents/perioperative-management-of-blood-glucose-in-adults-with-diabetes-mellitus?search=Perioperative%20management%20of%20blood%20glucose%20in%20adults%20with%20diabetes%20mellitus&source=search_result&selectedTitle=1∼150&display_rank=1. | 5 | A |
| •During the whole perioperative period, the perioperative blood glucose levels of diabetic patients and nondiabetic patients were monitored and maintained between 140 and 200 mg/dL (7.8 and 11 mmol/L). 14 Daniel Sessler. Perioperative temperature management. Accessed December 15, 2020.https://www.uptodate.cn/contents/delayed-emergence-and-emergence-delirium-in-adults?search=Perioperative%20temperature%20management&source=search_result&selectedTitle=2∼150&display_rank=2. | 5 | B |
| Classification | Protocol Details [References] | Level of Evidence | Recommendation Level |
|---|---|---|---|
| Perioperative fluid therapy | • The goal-oriented concept of liquid therapy is advocated, and reasonable liquid therapy schemes are formulated and implemented individually according to different therapeutic purposes, disease states, and stages. 10 ,11 ,16 ,Girish P Joshi. Anesthetic management for enhanced recovery after major surgery (ERAS) in adults. Accessed December 15, 2020.https://www.uptodate.cn/contents/anesthetic-management-for-enhanced-recovery-after-major-noncardiac-surgery-eras?search=Anesthetic%20management%20for%20enhanced%20recovery%20after%20major%20surgery%20(ERAS)%20in%20adults&source=search_result&selectedTitle=1∼150&display_rank=1. 22 ,24 ,25 ,
Enhanced recovery after surgery (ERAS) pathways in breast reconstruction: systematic review and meta-analysis of the literature. Breast Cancer Res Treat. 2019; https://doi.org/10.1007/s10549-018-4991-8 27
Implementing our microsurgical breast reconstruction enhanced recovery after surgery pathway: consensus obstacles and recommendations. Plast Reconstr Surg Glob Open. 2019; 7https://doi.org/10.1097/GOX.0000000000001855 | 1 | A |
| • It is recommended to use balanced crystal solution rather than brine. 16 ,Girish P Joshi. Anesthetic management for enhanced recovery after major surgery (ERAS) in adults. Accessed December 15, 2020.https://www.uptodate.cn/contents/anesthetic-management-for-enhanced-recovery-after-major-noncardiac-surgery-eras?search=Anesthetic%20management%20for%20enhanced%20recovery%20after%20major%20surgery%20(ERAS)%20in%20adults&source=search_result&selectedTitle=1∼150&display_rank=1. 27
Implementing our microsurgical breast reconstruction enhanced recovery after surgery pathway: consensus obstacles and recommendations. Plast Reconstr Surg Glob Open. 2019; 7https://doi.org/10.1097/GOX.0000000000001855 | 2 | B | |
| • It is recommended that vascular pressors support fluid management and will not have a negative impact on the free flap. 16 Girish P Joshi. Anesthetic management for enhanced recovery after major surgery (ERAS) in adults. Accessed December 15, 2020.https://www.uptodate.cn/contents/anesthetic-management-for-enhanced-recovery-after-major-noncardiac-surgery-eras?search=Anesthetic%20management%20for%20enhanced%20recovery%20after%20major%20surgery%20(ERAS)%20in%20adults&source=search_result&selectedTitle=1∼150&display_rank=1. | 5 | B | |
| Prevention and treatment of nausea and vomiting during perioperative period | • The simplified risk score for postoperative nausea and vomiting created by Apfel et al. 30 can be used to assess the risk of postoperative nausea and vomiting in adults before surgery and develop individualized prevention strategies according to the predicted risk degree.19 Jessica Feinleib, Lori H, Kwan Ammar Yamani. Postoperative nausea and vomiting. Accessed December 15, 2020.https://www.uptodate.cn/contents/postoperative-nausea-and-vomiting?search=Postoperative%20nausea%20and%20vomiting&source=search_result&selectedTitle=1∼102&display_rank=1. | 2 | B |
| • The prevention of postoperative nausea and vomiting in all patients should include multiple modes. The preventive intervention measures include the modification of anesthetics, avoiding general anesthesia, propofol general intravenous anesthesia (TIVA), antiemetic drugs, and acupuncture. Various antiemetic drugs can be used to prevent and treat postoperative nausea and vomiting. 19 , Jessica Feinleib, Lori H, Kwan Ammar Yamani. Postoperative nausea and vomiting. Accessed December 15, 2020.https://www.uptodate.cn/contents/postoperative-nausea-and-vomiting?search=Postoperative%20nausea%20and%20vomiting&source=search_result&selectedTitle=1∼102&display_rank=1. 27 ,
Implementing our microsurgical breast reconstruction enhanced recovery after surgery pathway: consensus obstacles and recommendations. Plast Reconstr Surg Glob Open. 2019; 7https://doi.org/10.1097/GOX.0000000000001855 28 | 2 | B | |
| • Promote the use of two antiemetics to reduce postoperative nausea and vomiting. 19 ,Jessica Feinleib, Lori H, Kwan Ammar Yamani. Postoperative nausea and vomiting. Accessed December 15, 2020.https://www.uptodate.cn/contents/postoperative-nausea-and-vomiting?search=Postoperative%20nausea%20and%20vomiting&source=search_result&selectedTitle=1∼102&display_rank=1. 27
Implementing our microsurgical breast reconstruction enhanced recovery after surgery pathway: consensus obstacles and recommendations. Plast Reconstr Surg Glob Open. 2019; 7https://doi.org/10.1097/GOX.0000000000001855 | 2 | B | |
| Perioperative pain management | • A postoperative acute pain management team, composed of anesthesiologists, surgeons, nurses, and pharmacists, should be established. 10 ,21 Edward R Mariano. Management of acute perioperative pain. Accessed December 15, 2020.https://www.uptodate.cn/contents/management-of-acute-perioperative-pain-in-adults?search=Management%20of%20acute%20perioperative%20pain&source=search_result&selectedTitle=1∼150&display_rank=1. | 5 | B |
| • Perioperative pain control using preventive and multimodal analgesia includes nonopioid analgesics, regional anesthesia techniques, local anesthetic wound infiltration, and nondrug analgesia strategies. 10 ,21 ,Edward R Mariano. Management of acute perioperative pain. Accessed December 15, 2020.https://www.uptodate.cn/contents/management-of-acute-perioperative-pain-in-adults?search=Management%20of%20acute%20perioperative%20pain&source=search_result&selectedTitle=1∼150&display_rank=1. 22 ,26 ,
Enhanced recovery after surgery pathway for microsurgical breast reconstruction: a systematic review and meta-analysis. Plast Reconstr Surg. 2018; https://doi.org/10.1097/PRS.0000000000005300 27
Implementing our microsurgical breast reconstruction enhanced recovery after surgery pathway: consensus obstacles and recommendations. Plast Reconstr Surg Glob Open. 2019; 7https://doi.org/10.1097/GOX.0000000000001855 | 1 | A | |
| • Visual analog scale, digital rating scale, and language rating scale should be used to evaluate the pain intensity of patients during rest and exercise in a timely manner. At the same time, the effect of postoperative pain treatment can be evaluated, and adverse reactions such as nausea, vomiting, pruritus and intestinal paralysis should be monitored and actively treated. 10 ,21 ,Edward R Mariano. Management of acute perioperative pain. Accessed December 15, 2020.https://www.uptodate.cn/contents/management-of-acute-perioperative-pain-in-adults?search=Management%20of%20acute%20perioperative%20pain&source=search_result&selectedTitle=1∼150&display_rank=1. 24 | 1 | A |
| Classification | Protocol Details [References] | Level of Evidence | Recommendation Level |
|---|---|---|---|
| Anesthesia management | • General intravenous anesthesia. 11 ,16 ,Girish P Joshi. Anesthetic management for enhanced recovery after major surgery (ERAS) in adults. Accessed December 15, 2020.https://www.uptodate.cn/contents/anesthetic-management-for-enhanced-recovery-after-major-noncardiac-surgery-eras?search=Anesthetic%20management%20for%20enhanced%20recovery%20after%20major%20surgery%20(ERAS)%20in%20adults&source=search_result&selectedTitle=1∼150&display_rank=1. 19 ,Jessica Feinleib, Lori H, Kwan Ammar Yamani. Postoperative nausea and vomiting. Accessed December 15, 2020.https://www.uptodate.cn/contents/postoperative-nausea-and-vomiting?search=Postoperative%20nausea%20and%20vomiting&source=search_result&selectedTitle=1∼102&display_rank=1. 22 ,25 ,
Enhanced recovery after surgery (ERAS) pathways in breast reconstruction: systematic review and meta-analysis of the literature. Breast Cancer Res Treat. 2019; https://doi.org/10.1007/s10549-018-4991-8 27
Implementing our microsurgical breast reconstruction enhanced recovery after surgery pathway: consensus obstacles and recommendations. Plast Reconstr Surg Glob Open. 2019; 7https://doi.org/10.1097/GOX.0000000000001855 | 1 | A |
| Hypothermia management | • The prevention and management of intraoperative hypothermia include preheating before the induction of anesthesia and active intraoperative warming. 14 ,Daniel Sessler. Perioperative temperature management. Accessed December 15, 2020.https://www.uptodate.cn/contents/delayed-emergence-and-emergence-delirium-in-adults?search=Perioperative%20temperature%20management&source=search_result&selectedTitle=2∼150&display_rank=2. 16 ,Girish P Joshi. Anesthetic management for enhanced recovery after major surgery (ERAS) in adults. Accessed December 15, 2020.https://www.uptodate.cn/contents/anesthetic-management-for-enhanced-recovery-after-major-noncardiac-surgery-eras?search=Anesthetic%20management%20for%20enhanced%20recovery%20after%20major%20surgery%20(ERAS)%20in%20adults&source=search_result&selectedTitle=1∼150&display_rank=1. 22 ,27 ,
Implementing our microsurgical breast reconstruction enhanced recovery after surgery pathway: consensus obstacles and recommendations. Plast Reconstr Surg Glob Open. 2019; 7https://doi.org/10.1097/GOX.0000000000001855 28 | 2 | A |
| • Temperature should be measured during surgery and on arrival in the postanesthesia care unit (PACU), intensive care unit (ICU) or return to the general ward. 14 ,Daniel Sessler. Perioperative temperature management. Accessed December 15, 2020.https://www.uptodate.cn/contents/delayed-emergence-and-emergence-delirium-in-adults?search=Perioperative%20temperature%20management&source=search_result&selectedTitle=2∼150&display_rank=2. 16 Girish P Joshi. Anesthetic management for enhanced recovery after major surgery (ERAS) in adults. Accessed December 15, 2020.https://www.uptodate.cn/contents/anesthetic-management-for-enhanced-recovery-after-major-noncardiac-surgery-eras?search=Anesthetic%20management%20for%20enhanced%20recovery%20after%20major%20surgery%20(ERAS)%20in%20adults&source=search_result&selectedTitle=1∼150&display_rank=1. | 2 | A | |
| • The patient's body temperature should be routinely monitored during the operation until the surgery is complete. The patient's central body temperature should be maintained at not less than 36° C by means of heating mattresses, pressurized air heating (fan) or circulating water heating systems, transfusion and infusion heating devices. 10 ,11 ,14 ,Daniel Sessler. Perioperative temperature management. Accessed December 15, 2020.https://www.uptodate.cn/contents/delayed-emergence-and-emergence-delirium-in-adults?search=Perioperative%20temperature%20management&source=search_result&selectedTitle=2∼150&display_rank=2. 16 Girish P Joshi. Anesthetic management for enhanced recovery after major surgery (ERAS) in adults. Accessed December 15, 2020.https://www.uptodate.cn/contents/anesthetic-management-for-enhanced-recovery-after-major-noncardiac-surgery-eras?search=Anesthetic%20management%20for%20enhanced%20recovery%20after%20major%20surgery%20(ERAS)%20in%20adults&source=search_result&selectedTitle=1∼150&display_rank=1. | 2 | A | |
| Intraoperative blood glucose control | • Intraoperative use of insulin to control blood glucose in patients with breast cancer who also have diabetes is close to normal (< 10 mmol/L), and attention is paid to avoid hypoglycemia. 15 Nadia A Khan, William A Ghali, Enrico Cagliero. Perioperative management of blood glucose in adults with diabetes mellitus. Accessed December 15, 2020.https://www.uptodate.cn/contents/perioperative-management-of-blood-glucose-in-adults-with-diabetes-mellitus?search=Perioperative%20management%20of%20blood%20glucose%20in%20adults%20with%20diabetes%20mellitus&source=search_result&selectedTitle=1∼150&display_rank=1. | 5 | B |
| Intraoperative prevention of venous thrombosis | • Thrombosis prevention using 5000 units of subcutaneous heparin 30- 60 min before surgery. 17 Kenneth A Bauer. Risk and prevention of venous thromboembolism in adults with cancer. Accessed December 15, 2020.https://www.uptodate.cn/contents/risk-and-prevention-of-venous-thromboembolism-in-adults-with-cancer?search=Risk%20and%20prevention%20of%20venous%20thromboembolism%20in%20adults%20with%20cancer&source=search_result&selectedTitle=1∼150&display_rank=1#H10. | 5 | B |
| • Intraoperative use of a lower limb compression device to prevent deep venous thrombosis of the lower limb. 17 Kenneth A Bauer. Risk and prevention of venous thromboembolism in adults with cancer. Accessed December 15, 2020.https://www.uptodate.cn/contents/risk-and-prevention-of-venous-thromboembolism-in-adults-with-cancer?search=Risk%20and%20prevention%20of%20venous%20thromboembolism%20in%20adults%20with%20cancer&source=search_result&selectedTitle=1∼150&display_rank=1#H10. | 2 | B |
| Classification | Protocol Details [References] | Level of Evidence | Recommendation Level |
|---|---|---|---|
| One-lung rehabilitation exercise | • Patients should be encouraged and assisted to experience deep breathing and effective cough as soon as possible after surgery to maintain airway patency. 10 ,11 | 5 | A |
| Early eating | • Patients should be encouraged to take oral liquid and food as soon as possible, preferably within 24 h after surgery. 10 ,11 ,12 ,22 ,27
Implementing our microsurgical breast reconstruction enhanced recovery after surgery pathway: consensus obstacles and recommendations. Plast Reconstr Surg Glob Open. 2019; 7https://doi.org/10.1097/GOX.0000000000001855 | 5 | A |
| Flap monitoring | • Routine monitoring of the affected flap should be performed postoperatively, including clinical observation (ie, color, skin temperature and blood supply in the flap area) and the use of equipment. Frequent monitoring is required in the first 72 h. A reasonable monitoring scheme may include monitoring every 24 h, monitoring every 2 h in the next 24 h, and monitoring every 3-4 hours in the next 24 h. 22 ,25 ,
Enhanced recovery after surgery (ERAS) pathways in breast reconstruction: systematic review and meta-analysis of the literature. Breast Cancer Res Treat. 2019; https://doi.org/10.1007/s10549-018-4991-8 27
Implementing our microsurgical breast reconstruction enhanced recovery after surgery pathway: consensus obstacles and recommendations. Plast Reconstr Surg Glob Open. 2019; 7https://doi.org/10.1097/GOX.0000000000001855 | 2 | A |
| Drainage tube indwelling and removal | • The catheter should be avoided or removed as soon as possible. Without special circumstances, the catheter can be removed 1-2 d after operation. 10 ,11 ,20 ,Deverick J Anderson, Daniel J Sexton.Antimicrobial prophylaxis for prevention of surgical site infection in adults. Accessed December 15, 2020.https://www.uptodate.cn/contents/antimicrobial-prophylaxis-for-prevention-of-surgical-site-infection-in-adults?search=Antimicrobial%20prophylaxis%20for%20prevention%20of%20surgical%20site%20infection%20in%20adults&source=search_result&selectedTitle=1∼150&display_rank=1. 22 ,27
Implementing our microsurgical breast reconstruction enhanced recovery after surgery pathway: consensus obstacles and recommendations. Plast Reconstr Surg Glob Open. 2019; 7https://doi.org/10.1097/GOX.0000000000001855 | 1 | A |
| • Without a conventional indwelling drainage tube, it is recommended to use an indwelling drainage tube in the case of infection in the surgical wound, poor blood supply in the anastomotic stoma, excessive tension, and other factors that may lead to poor healing. 10 ,11 ,22 ,27
Implementing our microsurgical breast reconstruction enhanced recovery after surgery pathway: consensus obstacles and recommendations. Plast Reconstr Surg Glob Open. 2019; 7https://doi.org/10.1097/GOX.0000000000001855 | 5 | B | |
| Incision management | • The suture removal time should be determined according to age, nutritional status, incision site, and local blood supply. 22 ,27
Implementing our microsurgical breast reconstruction enhanced recovery after surgery pathway: consensus obstacles and recommendations. Plast Reconstr Surg Glob Open. 2019; 7https://doi.org/10.1097/GOX.0000000000001855 | 5 | A |
| Early ambulation | • Patients should get out of bed within the first 24 h after surgery. 10 ,11 ,22 ,24 ,25 ,
Enhanced recovery after surgery (ERAS) pathways in breast reconstruction: systematic review and meta-analysis of the literature. Breast Cancer Res Treat. 2019; https://doi.org/10.1007/s10549-018-4991-8 27
Implementing our microsurgical breast reconstruction enhanced recovery after surgery pathway: consensus obstacles and recommendations. Plast Reconstr Surg Glob Open. 2019; 7https://doi.org/10.1097/GOX.0000000000001855 | 2 | A |
| Discharge standards and follow-up | • A quantifiable and operable discharge standard based on patient safety should be formulated, such as the restoration of a semi-liquid diet or oral adjuvant nutritional preparations. There should be no need for intravenous infusion therapy. Oral analgesic drugs can effectively relieve pain. Good wound healing, no signs of infection. Organ function in good condition, free movement. The patient agreed to discharge 10 ,11 . | 5 | A |
| • Follow-up and monitoring of patients after discharge should be strengthened, and telephone follow-up and guidance should be routinely conducted within 24-48 h after discharge. Then, 7-10 d after surgery, the patient should return for an outpatient visit, wound suturing, pathological examination results, and to discuss further antitumor treatment. 10 ,11 ,22 ,25 ,
Enhanced recovery after surgery (ERAS) pathways in breast reconstruction: systematic review and meta-analysis of the literature. Breast Cancer Res Treat. 2019; https://doi.org/10.1007/s10549-018-4991-8 27 ,
Implementing our microsurgical breast reconstruction enhanced recovery after surgery pathway: consensus obstacles and recommendations. Plast Reconstr Surg Glob Open. 2019; 7https://doi.org/10.1097/GOX.0000000000001855 28 | 2 | B | |
| • Clinical follow-up should continue at least until 30 d after surgery. 11 ,22 ,27
Implementing our microsurgical breast reconstruction enhanced recovery after surgery pathway: consensus obstacles and recommendations. Plast Reconstr Surg Glob Open. 2019; 7https://doi.org/10.1097/GOX.0000000000001855 | 5 | A | |
| • Potential complications should be expected and physicians should remain vigilant. A ‘green channel’ should be established to meet the needs of patients for rehospitalization due to complications at any time. 10 ,11 ,27 ,
Implementing our microsurgical breast reconstruction enhanced recovery after surgery pathway: consensus obstacles and recommendations. Plast Reconstr Surg Glob Open. 2019; 7https://doi.org/10.1097/GOX.0000000000001855 28 | 5 | A | |
| Health education | • Patients should be instructed not to exercise intensely for 4-6 wk to achieve optimal wound healing and reduce the risk of seroma or contour abnormalities in the donor site. 22 ,26 ,
Enhanced recovery after surgery pathway for microsurgical breast reconstruction: a systematic review and meta-analysis. Plast Reconstr Surg. 2018; https://doi.org/10.1097/PRS.0000000000005300 27 ,
Implementing our microsurgical breast reconstruction enhanced recovery after surgery pathway: consensus obstacles and recommendations. Plast Reconstr Surg Glob Open. 2019; 7https://doi.org/10.1097/GOX.0000000000001855 28 | 2 | A |
Discussion
Preoperative Stage
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Menaka Pai, James D Douketis. Prevention of venous thromboembolic disease in adult nonorthopedic surgical patients. Accessed December 15, 2020.https://www.uptodate.cn/contents/prevention-of-venous-thromboembolic-disease-in-adult-nonorthopedic-surgical-patients?search=Prevention%20of%20venous%20thromboembolic%20disease%20in%20adult%20nonorthopedic%20surgical%20patients&source=search_result&selectedTitle=1∼150&display_rank=1.
Kenneth A Bauer. Risk and prevention of venous thromboembolism in adults with cancer. Accessed December 15, 2020.https://www.uptodate.cn/contents/risk-and-prevention-of-venous-thromboembolism-in-adults-with-cancer?search=Risk%20and%20prevention%20of%20venous%20thromboembolism%20in%20adults%20with%20cancer&source=search_result&selectedTitle=1∼150&display_rank=1#H10.
Kenneth A Bauer, Gregory YH Lip Overview of the causes of venous thrombosis. Accessed December 15, 2020.https://www.uptodate.cn/contents/overview-of-the-causes-of-venous-thrombosis?search=Overview%20of%20the%20causes%20of%20venous%20thrombosis&source=search_result&selectedTitle=1∼150&display_rank=1.
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after surgery pathway for microsurgical breast reconstruction: a systematic review and meta-analysis.
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- et al.
Deverick J Anderson, Daniel J Sexton.Antimicrobial prophylaxis for prevention of surgical site infection in adults. Accessed December 15, 2020.https://www.uptodate.cn/contents/antimicrobial-prophylaxis-for-prevention-of-surgical-site-infection-in-adults?search=Antimicrobial%20prophylaxis%20for%20prevention%20of%20surgical%20site%20infection%20in%20adults&source=search_result&selectedTitle=1∼150&display_rank=1.
Deverick J Anderson, Daniel J Sexton.Antimicrobial prophylaxis for prevention of surgical site infection in adults. Accessed December 15, 2020.https://www.uptodate.cn/contents/antimicrobial-prophylaxis-for-prevention-of-surgical-site-infection-in-adults?search=Antimicrobial%20prophylaxis%20for%20prevention%20of%20surgical%20site%20infection%20in%20adults&source=search_result&selectedTitle=1∼150&display_rank=1.
- Stone JP
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- Sarmiento S
- et al.
Nadia A Khan, William A Ghali, Enrico Cagliero. Perioperative management of blood glucose in adults with diabetes mellitus. Accessed December 15, 2020.https://www.uptodate.cn/contents/perioperative-management-of-blood-glucose-in-adults-with-diabetes-mellitus?search=Perioperative%20management%20of%20blood%20glucose%20in%20adults%20with%20diabetes%20mellitus&source=search_result&selectedTitle=1∼150&display_rank=1.
- Stone JP
- Siotos C
- Sarmiento S
- et al.
Girish P Joshi. Anesthetic management for enhanced recovery after major surgery (ERAS) in adults. Accessed December 15, 2020.https://www.uptodate.cn/contents/anesthetic-management-for-enhanced-recovery-after-major-noncardiac-surgery-eras?search=Anesthetic%20management%20for%20enhanced%20recovery%20after%20major%20surgery%20(ERAS)%20in%20adults&source=search_result&selectedTitle=1∼150&display_rank=1.
- Stone JP
- Siotos C
- Sarmiento S
- et al.
Menaka Pai, James D Douketis. Prevention of venous thromboembolic disease in adult nonorthopedic surgical patients. Accessed December 15, 2020.https://www.uptodate.cn/contents/prevention-of-venous-thromboembolic-disease-in-adult-nonorthopedic-surgical-patients?search=Prevention%20of%20venous%20thromboembolic%20disease%20in%20adult%20nonorthopedic%20surgical%20patients&source=search_result&selectedTitle=1∼150&display_rank=1.
Kenneth A Bauer. Risk and prevention of venous thromboembolism in adults with cancer. Accessed December 15, 2020.https://www.uptodate.cn/contents/risk-and-prevention-of-venous-thromboembolism-in-adults-with-cancer?search=Risk%20and%20prevention%20of%20venous%20thromboembolism%20in%20adults%20with%20cancer&source=search_result&selectedTitle=1∼150&display_rank=1#H10.
Kenneth A Bauer, Gregory YH Lip Overview of the causes of venous thrombosis. Accessed December 15, 2020.https://www.uptodate.cn/contents/overview-of-the-causes-of-venous-thrombosis?search=Overview%20of%20the%20causes%20of%20venous%20thrombosis&source=search_result&selectedTitle=1∼150&display_rank=1.
- Stone JP
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- et al.
Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures an updated report by the American society of anesthesiologists task force on preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration.
- Sebai ME
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after surgery pathway for microsurgical breast reconstruction: a systematic review and meta-analysis.
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Deverick J Anderson, Daniel J Sexton.Antimicrobial prophylaxis for prevention of surgical site infection in adults. Accessed December 15, 2020.https://www.uptodate.cn/contents/antimicrobial-prophylaxis-for-prevention-of-surgical-site-infection-in-adults?search=Antimicrobial%20prophylaxis%20for%20prevention%20of%20surgical%20site%20infection%20in%20adults&source=search_result&selectedTitle=1∼150&display_rank=1.
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Deverick J Anderson, Daniel J Sexton.Antimicrobial prophylaxis for prevention of surgical site infection in adults. Accessed December 15, 2020.https://www.uptodate.cn/contents/antimicrobial-prophylaxis-for-prevention-of-surgical-site-infection-in-adults?search=Antimicrobial%20prophylaxis%20for%20prevention%20of%20surgical%20site%20infection%20in%20adults&source=search_result&selectedTitle=1∼150&display_rank=1.
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