Breast reconstruction patients having quicker recoveries

November 16, 2015

CALGARY — Many Calgary women undergoing mastectomy and breast reconstruction are leaving hospital sooner with the expansion of a program that offers a new way of caring for surgical patients.

Enhanced Recovery After Surgery (ERAS) is a set of practices before, during and after surgery that’s helping patients feel better faster while shortening hospital stays. It was first introduced at two hospitals in Alberta in 2013 for patients undergoing colorectal surgery.

“Patients I recommend for surgery using ERAS are initially surprised when I tell them they’ll be going home the same day,” says Dr. Claire Temple-Oberle, a surgeon who specializes in breast reconstruction with implants. “But they experience less nausea, are able to eat sooner, have less pain, and they sleep better by returning to their homes and families.”

A pilot study involving 29 of Dr. Temple-Oberle’s breast reconstruction patients showed there was no increase in post-operative complications using the ERAS protocols and same-day discharge. Without ERAS, those patients would have been hospitalized overnight.

A second and more involved type of breast reconstruction that uses abdominal tissue is also showing good results using ERAS, with time spent in hospital shortened from roughly seven days to five days on average.

With ERAS, patients receive anti-nausea and anti-inflammatory medications before surgery, and then different types of anesthetics and pain medications both during and after the surgery. By minimizing the use of narcotics, doctors are often able to prevent post-operative nausea.

“Patients are also enlisted as active members of their health care team,” Dr. Temple-Oberle says. “They’re asked to follow some instructions on nutrition before the surgery and we encourage them to get mobile afterwards.”

Kirsten Boulay, who had a double mastectomy and reconstruction with implants, says her friends were shocked when they learned she would be going home the same day.

“But I had a lot of confidence in my surgeons,” which included Drs. Temple-Oberle and May Lynn Quan, Boulay says. “I feel so fortunate to have been in a place that has this focus on patient recovery.”

Although she did experience some nausea when she woke up, Boulay says it was nowhere near as severe as what she had experienced in previous surgeries.

“Being at home is a more comforting and restful place to be,” Boulay says. “It allows you to physically and mentally move forward with your recovery.”

Glenda Bonney underwent the more extensive reconstruction with abdominal tissue and says she experienced hardly any nausea after an eight-hour surgery.

“The level of care was just incredible,” Bonney says. “I did not experience anywhere near the level of pain other people who had been through the same surgery told me I could expect.”

There are more than 350 mastectomies and breast reconstructions performed every year at Foothills Medical Centre. Using ERAS for this patient population is currently only being piloted in Calgary.

Jeannette Lawrence, the AHS lead for ERAS, says planning is underway to ensure the ERAS pathway can be offered to breast reconstruction patients across the province. According to estimates, provincewide adoption of the program could free up 1,600 bed days per year, improving access for Albertans who need inpatient care.

“The entire surgical team at the local, zone, and provincial level has come together to make ERAS a success,” Lawrence says. “We’re seeing better patient outcomes and reduced length of stay. It’s a win-win. Many of our clinicians who care for patients say this is the best work they have been a part of. Dr. Temple-Oberle and her team are another local example of great ERAS work that supports the Surgery Strategic Clinical Network’s goal to spread ERAS across Alberta and create care pathways for multiple types of surgeries.”

Plans are also being made to expand the use of ERAS for colorectal surgery to every hospital in the province that performs more than 100 procedures a year. Overall, patients’ recovery and surgery experience is better with ERAS care pathways than with traditional surgical care.

AHS’ Obesity, Diabetes and Nutrition Strategic Clinical Network (SCN) first piloted the ERAS project for colorectal surgery. The program is now led by the Surgery SCN as ERAS expands across the province to other surgical areas. SCNs are provincewide teams of patients and families, health care professionals, researchers, community leaders and policy-makers. Each network is working to reshape health care and enhance the patient journey, improve outcomes and standardize care across the province.

Alberta Health Services is the provincial health authority responsible for planning and delivering health supports and services for more than four million adults and children living in Alberta. Its mission is to provide a patient-focused, quality health system that is accessible and sustainable for all Albertans.