A Single-Institution Case Series of Outpatient Same-Day Mastectomy: Implementation of a Quality Improvement Project and Initiative for Enhanced Recovery After Surgery

Bakeer, Mohamed-Aly; Coker, Cameron; Atamian, Elisa K.; Yoo, Daniel; Torabi, Radbeh; Riker, Adam I.

doi:10.31486/toj.20.0040

Cited by 12 publications

(14 citation statements)

References 19 publications

(3 reference statements)

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“…11 Several other single institutions have reviewed the safety of their SDM protocols and have reported similar advantages of shorter LOS and lower hospital costs. [12][13][14][15][16] These smaller studies have been somewhat limited in their findings as single-center experiences. Thus, the question is if these favorable outcomes with SDM can be widely applied and implemented at the national level.…”

Section: Discussionmentioning

confidence: 99%

“…Intraoperative regional nerve blocks can be successfully achieved with long-acting anesthetics, such as liposomal bupivacaine via a multilevel midaxillary intercostal nerve block. 12 A multimodal approach to pain management has been shown to result in significantly lower pain scores in the recovery room, reduce perioperative opioid consumption, decrease postoperative nausea and vomiting, and shorten LOS. [17][18][19][20][21] Several patient characteristics are associated with 1-day LOS.…”

Section: Discussionmentioning

confidence: 99%

“…The pandemic forced many institutions to re-examine their approach and criteria for patients who truly require an overnight hospital stay, and this effort increased interest in developing and implementing SDM protocols that minimize the need for an overnight hospital stay. [12][13][14][15][16] However, whether the safety of SDM demonstrated at single integrated health care centers is generalizable to other institutions at the national level remains unclear. The primary purpose of this study was to examine 30-day outcomes of SDM using a large national database.…”

Section: Introductionmentioning

confidence: 99%

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Hospital-Based Same-Day Compared to Overnight-Stay Mastectomy: An American College of Surgeons National Surgical Quality Improvement Program Analysis

Sibia

Klune

Turcotte

et al. 2022

TOJ

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Background: Enhanced Recovery after Surgery for mastectomy has resulted in increased use of outpatient same-day mastectomy (SDM). Whether SDM leads to increased readmissions or reoperations is not well documented. This study examines national data to compare outcomes of SDM to an overnight stay. Methods: We analyzed the American College of Surgeons National Surgical Quality Improvement Program Participant Use Data File from 2016 to 2018 for all mastectomy cases. Cases with a length of stay (LOS) >1 day were excluded. Cases were then categorized into 2 LOS cohorts: SDM vs 1-day LOS. Results: A total of 22,642 cases (80.8% 1-day LOS vs 19.2% SDM) were identified for the final analysis. Patients in the 1-day LOS group were more likely to be older (57.9 vs 54.0 years, P<0.01), be female (98.0% vs 79.8%, P<0.01), and have greater comorbidity (38.1% vs 30.7% American Society of Anesthesiologists classification 3 or 4, P<0.01) compared to the SDM group. Multivariate analysis demonstrated no difference in risk for 30-day wound complications between the SDM and 1-day LOS groups. The risks for 30-day medical complications (1.60 odds ratio [OR], 95% CI 1.06-2.42, P=0.02), reoperations (1.46 OR, 95% CI 1.17-1.81, P<0.01), and readmissions (1.60 OR, 95% CI 1.25-2.05, P<0.01) were higher in the 1-day LOS group. Even after excluding patients undergoing reoperation on the day of surgery, the risk for reoperations (2.3% vs 3.3%, P<0.01) remained higher in the 1-day LOS group. Characteristics associated with 1-day LOS were hypertension, steroid use, diabetes, dyspnea, dependent functional status, bilateral procedures, and breast reconstruction. Conclusion:We demonstrate that SDM is a safe procedure, with no increase in risk for 30-day postoperative complications. Appropriate patients should be offered SDM.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Hospital-Based Same-Day Compared to Overnight-Stay Mastectomy: An American College of Surgeons National Surgical Quality Improvement Program Analysis

Sibia

Klune

Turcotte

et al. 2022

TOJ

Self Cite

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“…With the incorporation of ERAS into plastic surgery over the last two decades, studies have demonstrated decreased opioid usage, as well as decreased hospital resources. 22 , 25 , 38 , 39 Dumestre et al 34 reported that enhanced recovery patients had decreased severe pain and nausea, while increasingly enjoying their food and feeling more rested. Similarly, Schwartz 36 reported that patient satisfaction was higher among immediate reconstructions with same-day discharge performed in an ambulatory surgery center.…”

Section: Discussionmentioning

confidence: 99%

The Safety of Same-day Discharge after Immediate Alloplastic Breast Reconstruction: A Systematic Review

Marxen

Shauly

Losken

2022

Plastic and Reconstructive Surgery - Global Open

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Background: Implant-based breast reconstruction can be accomplished in a variety of ways and can result in vastly different postoperative experiences for patients. The COVID-19 pandemic and recent trends have resulted in a shift toward outpatient management of these patients. Methods: A systematic review of PubMed and Embase databases was conducted. A total of 1328 articles were identified on initial search, and after several rounds of review, a total of four met inclusion and exclusion criteria. Manuscripts were included if postmastectomy alloplastic breast reconstruction was performed, and there was documentation of same-day discharge. This cohort of patients was compared with traditional, planned overnight admission cohorts found in the literature. Objective data compared between groups included preoperative patient factors and postoperative complication rates. Results: Four studies representing data on a total of 574 patients were included: 289 were same-day discharge and 285 were overnight admission. Patient characteristics of body mass index, radiation, smoking, and bilateral procedures were comparable. Tissue expanders were used more frequently than implants in both cohorts. The rate of overall complications was 33% for same-day discharge and 34% for overnight admission. Rates of major and minor complications, including infection, seroma, and hematoma, were similar. There was no increase in reoperations or readmissions reported in any of the studies. Conclusions: Same-day discharge after mastectomy with immediate alloplastic reconstruction is a safe approach to treatment in both the ambulatory and hospital setting. There are comparable rates of common complications such as infection, seroma, and hematoma, with no increase in readmission or reoperation.

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“… 2 More recently, this evidence based approach to surgical recovery has expanded beyond major abdominal surgery and has been shown to be effective in breast surgery with or without alloplastic reconstruction; tailored perioperative education and planning must address the unique needs of women with breast cancer. 3 – 5 Other authors have demonstrated the feasibility of same-day discharge after mastectomy without increased complication rates, emergency department return visits, or postoperative hospitalizations. 3 , 6…”

mentioning

confidence: 99%

Editorial Comment on: One-Year Experience of Same-Day Mastectomy and Breast Reconstruction Protocol

et al. 2022

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A Single-Institution Case Series of Outpatient Same-Day Mastectomy: Implementation of a Quality Improvement Project and Initiative for Enhanced Recovery After Surgery

Cited by 12 publications

References 19 publications

Hospital-Based Same-Day Compared to Overnight-Stay Mastectomy: An American College of Surgeons National Surgical Quality Improvement Program Analysis

Hospital-Based Same-Day Compared to Overnight-Stay Mastectomy: An American College of Surgeons National Surgical Quality Improvement Program Analysis

The Safety of Same-day Discharge after Immediate Alloplastic Breast Reconstruction: A Systematic Review

Editorial Comment on: One-Year Experience of Same-Day Mastectomy and Breast Reconstruction Protocol

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