ENHANCED RECOVERY CARE PROGRAMME FOR ABDOMINAL-BASED BREAST RECONSTRUCTIONS (MS-TRAM/DIEP)

Transcription

1 St Andrews Centre for Plastic Surgery ENHANCED RECOVERY CARE PROGRAMME FOR ABDOMINAL-BASED BREAST RECONSTRUCTIONS (MS-TRAM/DIEP) INTRODUCTION This leaflet aims to help you understand the Enhanced Recovery Programme at St Andrew s Centre for Plastic Surgery. It is important that you understand what to expect and how you can play an active part in your recovery. If there is anything you are unsure about, please ask a member of staff or call one of the numbers at the end of this leaflet. ENHANCED RECOVERY PROGRAMME The Enhanced Recovery Programme is an evidence-based approach to optimising your condition and to help you recover from your operation more quickly. The programme has input from the multi-disciplinary team, which includes the surgeons, anaesthetists, specialist breast reconstruction nurses, enhanced recovery nurses and physiotherapists. However, it is very important that you actively participate and focus on your own recovery process. Benefits The Enhanced Recovery Programme started in the early 1990 s in Europe and was adopted by the NHS at the beginning of the millennium. The Enhanced Recovery Programme is now well established as safe and effective in the improvement of patient experience, better clinical outcomes and a reduction in length of hospital stay following surgery. Risk There are no additional risks to you from this programme of care. The Enhanced Recovery Programme is designed to help you to recover from the surgery more quickly and potentially reduce the length of stay in hospital. PRIOR TO OPERATION Pre-operative assessment You will attend a pre-assessment clinic appointment in the outpatients department before your surgery, for the nurses and doctors to assess you and to ensure that all preparations have been completed to optimise your condition before surgery. You will be given a prescription for an injection of a medication called Clexane. This is to be injected into the skin of the inner thigh on the day before coming in for the surgery. You Enhanced Recovery Care Programme for Abdominal-Based Breast Reconstructions Page 1 of 5

2 will be taught how to do this yourself. If you are not able to do this yourself, we would ask you to arrange for your practice nurse to administer this around 4pm on the day before your operation. This helps reduce the risk of blood clots (thrombosis). This will also be given to you each evening while you are in hospital. You will be required to wear specialist stockings while you are in hospital as these also help to prevent blood clots. Managing expectations Information will be given and we will talk to you about your operation and the Enhanced Recovery Programme. You will get the opportunity to attend our Breast Reconstruction Awareness (BRA) group meeting to see and speak to patients who have been through the same operation. You will be able to see the outcomes of their surgery and to share their experiences of the reconstruction journey. You will be given a patient diary to complete whilst in the hospital, this is to help you and us to monitor the progress of your recovery. What can I eat and drink before the operation? You can eat normally until 6 hours before your operation and you can drink clear fluids (black tea or coffee, squash or water) up to 2 hours before your surgery. You will be given a protein drink to have on the night before your surgery and on the day of surgery. This drink is specially designed to give your body additional nourishment and to help in your recovery. It is important that you drink these no later than the time stated below: Night before the surgery 7 pm on the night before the surgery Mix the two sachets of Preload with 800ml of water. Morning of the surgery (morning list) 5:00 am on the morning of the surgery Mix the one sachet of Preload with 400ml of water. Morning of the surgery (afternoon list) 10:00am on the morning of the surgery Mix the one sachet of Preload with 400ml of water. DAY OF YOUR OPERATION You will be admitted to hospital on the day of your operation. It is important that you arrive on the ward at 7:00am and keep yourself warm on your way to the hospital. When you arrive on the ward, you will be seen by various members of the team who will be caring for you, before, during and after your surgery. Nursing Staff The staff on the ward will ask you some questions for what is called a pre-operative check list. This is to check that there has been no change in your circumstances since your preadmission clinic visit. Enhanced Recovery Care Programme for Abdominal-Based Breast Reconstructions Page 2 of 5

3 Surgeon A member of the team who will be performing your surgery will see you, confirm your surgery and answer any concerns you may have. Consent for the surgery should already have been taken in the outpatient clinic. The surgeon will also draw markings for the surgery on your skin with a washable ink marker pen. Anaesthetist An anaesthetist will see you before your surgery to discuss the type of anaesthetic and the types of pain relief available after your surgery. We aim to keep you comfortable at all times with a combination of analgesia. For example, regular paracetamol, a non-steroidal anti-inflammatory agent (NSAID) and minimal opioids would be used to control postoperative pain thus allowing you to mobilise without pain earlier. Anti-sickness drugs will be given routinely in surgery and for the first 24 hours following surgery to minimise the risk of post-operative nausea and vomiting (PONV). POST OPERATION Nutrition You are encouraged to commence drinking as soon as possible after surgery and build up to a full diet progressively as soon as this can be tolerated. Energy drinks that were given in the pre-operative period provide further nutrition in the immediate post-operative period. Drains and catheter To assist mobilisation and help reduce the risk of infection, drains and urinary catheters (a tube passed up into the bladder) are removed as early as possible after surgery. This will vary dependent on the volume of fluid drainage from the surgical sites and your mobilisation status. Rehabilitation To enable early rehabilitation, minimisation of pain, nausea and vomiting control, continuous encouragement to achieve your discharge goals will be re-iterated. Physiotherapy A member of the physiotherapy team will see you from day 1 post surgery to assist and advise you on respiratory function, your mobility, shoulder exercises and general discharge advice. Enhanced Recovery Care Programme for Abdominal-Based Breast Reconstructions Page 3 of 5

4 HOSPITAL STAY We anticipate that you will be discharged home around 5 days after your surgery, although some women go home earlier than this. This will depend on whether you are meeting a number of criteria (goals). The discharge criteria You can be discharged when you have met all of the following: You are comfortable and pain is well controlled You are eating and drinking well You are able to shower and dress yourself You are able to walk to the toilet independently Your wounds are healing well and there are no signs of infection You have someone to come and collect you on discharge The aim of the Enhanced Recovery Programme is to work with you towards achieving the discharge goals. POST DISCHARGE Complications do not happen very often but it is important that you know what to look out for should you feel unwell. This will be explained to you before discharge. If you are worried, please phone one of the contact numbers at the end of this leaflet. If you cannot contact us, then ring your GP. Physiotherapy follow up will be held at 2, 4 and 6 weeks post surgery to progress your exercise and to advise you on returning to normal activities. GENERAL ADVICE Driving You should always speak with your insurance company before coming into hospital as your insurance policy may be affected. Your physiotherapist can advise you when you have regained your shoulder movement and strength to allow you to drive, normally approximately 6 weeks post surgery. Travel Please check with your consultant/gp before flying especially on long haul flights. Long car journeys are also best avoided for at least 12 weeks following your operation. Air travel should be avoided for 4 months following surgery. Work If you work we advise that you discuss with your employer the need for time off work after your operation, and support on your return to work, before coming into hospital. Enhanced Recovery Care Programme for Abdominal-Based Breast Reconstructions Page 4 of 5

5 GLOSSARY OF TERMS MS-TRAM Muscle-sparing transverse rectus abdominis myocutaneous flap. Reconstruction of the breast using abdominal fat and some abdominal muscle. DIEP Deep inferior epigastric perforator flap. Reconstruction of the breast using abdominal fat only. Contacts / Further Information Location Number(s) Broomfield Hospital Switchboard Breast Reconstruction Nurses or Outpatient Physiotherapy Plastic Surgery Outpatient Appointments Stock Ward or All conflicts of information have been disclosed prior to the development of this Patient Information Leaflet. Please ask if you require this information in other languages, large print, easy read accessible information, audio/visual, signing, pictorial and change picture bank forma via the Patient Advisory Liaison Service (PALS) on (01245) Mid Essex Hospital services NHS Trust is smoke-free. You cannot smoke on site. For advice on quitting, contact your GP or the NHS smoking helpline free, Charitable donations can make a very real difference to the level of patient care at our Trust. As well as contributing to new facilities, donations can be used to buy specialist equipment and smaller items to make patient s stay in hospital more comfortable. For information about making a donation please contact the Charities Office on or visit the website at: Document History Department Plastic Surgery Published/Review: December 2014 / November 2017 File name Enhanced Recovery Care Programme for Abdominal-Based Breast Reconstructions Version/ref no 1.1 / MEHT Enhanced Recovery Care Programme for Abdominal-Based Breast Reconstructions Page 5 of 5