Breast cancer surgery in an ambulatory setting

Rovera, Francesca; Ferrari, Alberta; Marelli, Marina Montagnani; Bellani, Marco Luigi; Limonta, Giorgio; Corben, Adriana D.; Dionigi, Gianlorenzo; Boni, Luigi; Uccella, Laura; Carcano, Giulio; Dionigi, Renzo

doi:10.1016/j.ijsu.2008.12.006

Cited by 21 publications

(21 citation statements)

References 9 publications

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“…Yet another major benefit of ambulatory surgery is the significant cost savings resulting from shorter hospital stays [8, 10–13, 17–20]. This has particular relevance in our local context.…”

Section: Discussionmentioning

confidence: 99%

Adopting Ambulatory Breast Cancer Surgery as the Standard of Care in an Asian Population

Chan

Chen

et al. 2014

International Journal of Breast Cancer

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Introduction. Ambulatory surgery is not commonly practiced in Asia. A 23-hour ambulatory (AS23) service was implemented at our institute in March 2004 to allow more surgeries to be performed as ambulatory procedures. In this study, we reviewed the impact of the AS23 service on breast cancer surgeries and reviewed surgical outcomes, including postoperative complications, length of stay, and 30-day readmission. Methods. Retrospective review was performed of 1742 patients who underwent definitive breast cancer surgery from 1 March 2004 to 31 December 2010. Results. By 2010, more than 70% of surgeries were being performed as ambulatory procedures. Younger women (P < 0.01), those undergoing wide local excision (P < 0.01) and those with ductal carcinoma-in situ or early stage breast cancer (P < 0.01), were more likely to undergo ambulatory surgery. Six percent of patients initially scheduled for ambulatory surgery were eventually managed as inpatients; a third of these were because of perioperative complications. Wound complications, 30-day readmission and reoperation rates were not more frequent with ambulatory surgery. Conclusion. Ambulatory breast cancer surgery is now the standard of care at our institute. An integrated workflow facilitating proper patient selection and structured postoperativee outpatient care have ensured minimal complications and high patient acceptance.

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Section: Discussionmentioning

confidence: 99%

Adopting Ambulatory Breast Cancer Surgery as the Standard of Care in an Asian Population

Chan

Chen

et al. 2014

International Journal of Breast Cancer

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“…There is mounting evidence supporting the safety and feasibility of day‐case breast surgery . Day case is defined as the discharge of patient from hospital by midnight on the day of surgery.…”

Section: Introductionmentioning

confidence: 99%

“…18 There is mounting evidence supporting the safety and feasibility of day-case breast surgery. [19][20][21] Day case is defined as the discharge of patient from hospital by midnight on the day of surgery. The British Association of Day Surgery (BADS) suggests a day-case rate of 30% for mastectomies.…”

Section: Introductionmentioning

confidence: 99%

Increasing the incidence of drain‐free day‐case mastectomies with the use of a fibrin tissue sealant; data from a single surgical center in the United Kingdom

et al. 2019

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Day‐case mastectomy surgery provides benefits to both patients and hospitals. Key barriers are the use of a drain and the risk of postoperative seroma formation. We introduced the use of a tissue sealant (Artiss) into the surgical site (post‐mastectomy without immediate reconstruction and postaxillary clearance) and evaluated its effect on our practice, particularly day‐case rates. A prospective audit of 177 patients who underwent a simple mastectomy with or without axillary surgery, or axillary node clearance with or without breast‐conserving surgery was conducted at a single surgical center in the UK between November 2015 and November 2016. Artiss was used in all operations and, where appropriate, the drain was omitted to facilitate day‐case surgery. The clinical outcomes were compared between patients undergoing different operations and duration of hospital stay. There was no statistically significant difference between day‐case patients and inpatients in seroma aspiration rates (24.5% and 21.7%, respectively; P = 0.381) or other complications (22.4% and 16.1%, respectively; P = 0.106). The day‐case mastectomy rate increased from 3.9% in the first quarter to 45.5% in the final quarter, which was a significant increase reaching well beyond the national target. The use of Artiss enabled us to increase the drain‐free day‐case surgery rates over a 1‐year period, exceeding the 30% target recommended by the British Association of Day Surgery. We did not observe any increase in patient morbidity, and the change was cost‐effective. We have now implemented the routine use of Artiss in women undergoing simple mastectomy with or without axillary surgery and stand‐alone axillary node clearances as part of enhanced recovery clinical pathways.

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“…Previous literature documents that breast cancer surgery including quadrantectomies, axillary lymphoadenectomies, simple or radical modified mastectomies, and sentinel lymph node biopsies represents a good choice as an outpatient procedure ''when it is superficial and does not imply any significant bleeding or electrolyte shifts.'' 4 Moreover, previous studies show no evidence of differences in quality or outcomes of health care between patients receiving outpatient breast cancer surgery compared with those receiving inpatient surgery. 5 Warren et al conducted a large population-based study to explore utilization trends and outcomes after outpatient mastectomy (OM) in the US Their study included all women aged 65 and older in the fee-for-service Medicare program between 1986 and 1995.…”

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confidence: 96%

Influence of physician, patient, and health care system characteristics on the use of outpatient mastectomy

Shahbazi

Woods

2016

The American Journal of Surgery

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Breast cancer surgery in an ambulatory setting

Abstract: This study confirms the feasibility, efficacy and safety of the outpatient setting regime, which is highly appreciated by women and is more cost effective than surgery in a hospital setting.

Cited by 21 publications

References 9 publications

Adopting Ambulatory Breast Cancer Surgery as the Standard of Care in an Asian Population

Adopting Ambulatory Breast Cancer Surgery as the Standard of Care in an Asian Population

Increasing the incidence of drain‐free day‐case mastectomies with the use of a fibrin tissue sealant; data from a single surgical center in the United Kingdom

Influence of physician, patient, and health care system characteristics on the use of outpatient mastectomy

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