1296 A Closed Loop Audit to Evaluate the Enhanced Recovery After Surgery (ERAS) Protocol in a Tertiary Oncoplastic Breast Reconstruction Unit

Aim A closed loop audit to assess the enhanced recovery after surgery (ERAS) protocol before and after implementation of an ERAS proforma, in patients who have undergone breast free flap reconstruction. To analyse the impact on patients after implementation. Method Retrospective data collection from March to June 2022 and September to November 2023, in a tertiary oncoplastic breast unit. Inclusion criteria: all patients who had undergone breast free flap reconstruction for breast cancer. Thirty-one patients in total. An ERAS proforma was designed in line with Trust standards and based on input from the oncoplastic breast MDT. The proforma included the following categories: pre-operation, operation day, day one, two and three post operation. The data was collected, analysed, and compared to data collected before implementation. Results The first audit showed poor adherence to the ERAS protocol, this improved after implementation of an ERAS proforma in the following areas: location of the proforma in notes, 0% found in notes before, 92% after. Anti-emetics prescribed 32% before and 100% after. Anti-inflammatory medication plus proton pump inhibitor prescribed 32% before and 100% after. Analgesia, laxatives, and enoxaparin prescribed in 100% of patients before and after implementation. Day 1 TWOC occurred 0% before and 50% after implementation. Day 2 drain documentation/management 26% before and 100% after. The average length of hospital stay was 5.5 days before, 3.75 days after. Therefore, inpatient hospitalisation was reduced by 1.75 days. Conclusions Adherence to an ERAS protocol is beneficial in managing patients during the perioperative period and leads to reduced inpatient hospitalisation.