Abstract P6-14-03: Effectiveness of a breast reconstruction program with early discharge

Abstract

Background For the last decade, there has been a significant reduction in hospital length of stay (LOS) after breast cancer surgery, and the last few years there is a tendency of early discharge (ED) rates following mastectomy. We defined same-day surgery (SDS) as admission, surgery and discharge on the same day and ED as hospital length of stay less than 36 hours. Studies show clear benefits with breast cancer patients having SDS such as reduction of hospital and patient costs, faster patient psychological recovery, lower rates of surgical complications and significant reduction of surgical site infection. However, concerns about performing more invasive procedures in an outpatient basis, such as immediate breast reconstruction (BR) is noticeable and few articles addresses this subject. At our institute our goal is to have an early and safely discharge for every patient with low complication rate, independently of the procedure (except for microvascular BR). We sought to describe our early discharge BR program in terms of complication rate and analyze risk factors for one-night hospitalization. Methods IRB approval was obtained for a retrospective review of all BR procedures performed from 2017- 2019 in the National Cancer Institute of Mexico. We selected patients who underwent BR surgeries with or without associated oncologic procedure in a basis of ED mode. Exclusion criteria were microvascular BR and patients who were not admitted the same day of surgery. We analyzed immediate and delayed BR (alloplastic or autologous), oncoplastic procedures and revision surgeries (complications). Demographic, clinical and surgical variables were analyzed in the bivariate analysis. And a logistic regression was used to determine possible risk factors for > 24 hours length of stay (LOS). Results A total of 456 patients were submitted to 692 total breast reconstruction surgeries. We categorized surgical events into 2 groups according to LOS: 419 (61%) in the SDS group with < 24 hours LOS and 273 (39%) in the > 24 hours group. The SDS group had a higher median age (46.7 years versus 44.8; p=0.0265), similar rates of diabetes, systemic hypertension, other comorbidities and ASA class. There is a greater proportion of patients with overweight in the SDS group (47.7% versus 33.7%; p=0.004). SDS group had a median LOS of 9.2 ±2.6 hours versus 33.1± 17.5 hours in the > 24 hours group (p=0.000). In the > 24 hours group the proportion of bilateral surgeries was 29.6% versus 36.8% (p=0.457), MT with alloplastic BR 59.7% versus 24.6% (p=0.000), and axillary lymph node surgery 55% versus 24.5% (p=0.000). Among all surgeries, 131 (18.9%) presented postoperative complications, 14.6% in the SDS group versus 25.6% (p=0.000). The quantity of reconstruction failures was 16 (4.8%). Most common complications were: 10.7% surgical site infection (9.1% in the SDS group versus 13.2%), 9.4 reintervention (7.4% SDS group versus 12.5%),13.6% of emergency room consultation (12.4% SDS group versus 14.3%), 0.6% hematoma. In the multivariate analysis we found significant risk factors for >24 hours LOS were a low educational level, low hemoglobin level, quantity of drains, length of surgery and certain types of surgery such as MT with immediate BR, oncoplastic surgery and autologous BR and presence of axillary lymph node surgery. Conclusions These results demonstrate that an ED breast cancer reconstruction program is safe and effective at our institution. The complication rate for our population is similar to other reported. We also found very positive that although there is no significant difference in complications, reinterventions or readmissions between >24 hours group and patients discharged the same day, there is a slight difference towards less complications in the SDS group which support continue reinforcing our SDS BR program. Citation Format: Juan Enrique Bargallo-Rocha, Daniela Vargas-Salas, Luz M Gutiérrez-Zacarías, Juan A Torres-Domínguez, Judith Acosta-Violante, Erick H Rubio-Arroyo. Effectiveness of a breast reconstruction program with early discharge [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-14-03.