[AVBC 2025] ERAS Implementation in Autologous Breast Reconstruction
Care Process & Redesign
Appropriate & Value-based Care Conference
SingHealth
6 November 2025
To implement an Enhanced Recovery After Surgery (ERAS) protocol to optimize clinical outcomes and cost efficiency in. The structured ERAS protocol significantly improved recovery and reduced hospital stay duration for post-mastectomy breast.
Year Submitted: 2025
Published Date: 06 November 2025
Tags: Care Process ＆ Redesign, Workflow Redesign, Quality Improvement, Cost Saving, Productivity, Value Based Care, Length Of Stay, Clinical Practice Improvement, Functional Outcome
About this Content
Aims
To implement an Enhanced Recovery After Surgery (ERAS) protocol to optimize clinical outcomes and cost efficiency in autologous breast reconstruction.
Background
Breast cancer is the most prevalent female malignancy in Singapore, with rates tripling since 1960. For patients requiring mastectomy, autologous reconstruction is an important option. However, optimizing post-operative care and recovery remains challenging. A critical performance gap was identified: only 44.5% of patients achieved the target length of stay (LOS) of 8 days between October 2020 and September 2021.
Methods
A comprehensive ERAS protocol was implemented through a staged approach: Phase 1: Targeted pilot with two high-volume surgeons (October 2021-February 2022), Phase 2: Departmental implementation (July 2023 onwards), In June 2023, quality standards were enhanced with a reduction in target LOS from 8 to 7 days.
Results
Implementation of the ERAS protocol significantly improved recovery and reduced hospital stay duration. Sustained improvements were observed across both original and enhanced LOS targets, with lower complication rates. The ERAS group had lower 30-day complication rates (9.3% vs 17.6% in the non-ERAS group) and an estimated annual cost avoidance of SGD$263,000 for 104 patients.
Conclusion
The structured ERAS protocol significantly improved recovery and reduced hospital stay duration for post-mastectomy breast reconstruction patients. The evidence-based approach provides a framework for standardizing complex surgical care pathways while improving outcomes and reducing costs.
Lessons Learnt
Unrealistic patient expectations on drain care management and lack of standardized perioperative care protocol were primary barriers. Phase 2 implementation was delayed due to COVID-19 disruptions, staffing constraints, and departmental training needs.
Additional Information
The project references the Singapore Cancer Registry Annual report 2018.
Keywords
Enhanced Recovery After Surgery, Breast Cancer, Mastectomy
Innovators' Details
Innovators' Details
Healthcare Cluster(s) | SingHealth |
Organization(s) Involved | Singapore General Hospital |
Platform(s) | Appropriate & Value-based Care Conference |
Healthcare Professional Group(s) | Medical |
Applicable Specialty or Discipline | Surgery |
Project Lead(s) | Liang Leer |
Project Member(s) | Sia Wan Jin |
Connect with this contributor!
Liang Leer - liang.leer@sgh.com.sg