Ambulatory surgery for the patient with breast cancer: current perspectives

Abstract

Ambulatory breast cancer surgery is well accepted and is the standard of care at many tertiary centers. Rather than being hospitalized after surgery, patients are discharged on the day of surgery or within 23 hours. Such early discharge does not adversely affect patient outcomes and has the added benefits of better psychological adjustment for the patient, economic savings, and a more efficient utilization of health care resources. The minimal care needed post-discharge also means that the caregiver is not unduly burdened. Unplanned conversions to inpatient admission and readmission rates are low. Wound complications are infrequent and no issues with drain care have been reported. Because the period of postoperative observation is short and monitoring is not as intensive, ambulatory surgery is only suitable for low-risk procedures such as breast cancer surgery and in patients without serious comorbidities, where the likelihood of major perioperative events is low. Optimal management of pain, nausea, and vomiting is essential to ensure a quick recovery and return to normal function. Regional anesthesia such as the thoracic paravertebral block has been employed to improve pain control during the surgery and in the immediate postoperative period. The block provides excellent pain relief and reduces the need for opiates, which also consequently reduces the incidence of nausea and vomiting. The increasing popularity of total intravenous anesthesia with propofol has also helped reduce the incidence of nausea and vomiting in the postoperative period. Ambulatory surgery can be safely carried out in centers where there is a well-designed workflow to ensure proper patient selection, counseling, and education, and where patients and caregivers have easy access to medical services should problems arise after discharge.

Healthcare delivery to elderly and unfit patients with breast disease and comorbidities under an outpatient regime: A report of a personal surgical technique named “Cut&Sew”

“…Such great institutional bias may contribute to increasing the use of discretionary surgical procedures in ambulatory surgery for breast diseases [ 32 ]. Therefore, the need for advisable and targeted surgical techniques requiring no drainage and local anesthesia [ 33 ] limiting pain, vomiting, perioperative anxiety, and post-operative complications in frail and comorbid patients is strongly advised [ 27 ].…”

“…In our opinion, outpatient surgery represents a precious and safe alternative only when performed in a context in which the patient is accurately prepared preoperatively and strictly controlled post-operatively. However, ambulatory management has become the standard in many countries for the surgical treatment of BC [ 17 , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] ]. The monitoring duration in hospitals is shorter (less than 12 h) and allows for decreased cost and waiting time for surgical care.…”