Enhancing the clinical pathway for patients undergoing axillary lymph node dissection

Barry, Mitchel; Weber, Walter; Lee, S.; Mazzella, A; Sclafani, Lisa M.

doi:10.1016/j.breast.2011.10.002

Cited by 15 publications

(8 citation statements)

References 6 publications

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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%

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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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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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“…It is a fruitful strategy: no increased morbidity has been noted between patients undergoing breast surgery for cancer as a day-case procedure and those staying as an inpatient [10,11]. Others have shown that axillary lymph node dissection and neck dissection can be done safely as a day-case procedure or with the patients discharged the following day [12,13]. Moreover, patients discharged earlier tend to fare better in terms of pain, mobility and self-confidence [14].…”

Section: Discussionmentioning

confidence: 97%

Introducing an enhanced recovery after surgery (ERAS) pathway for regional lymph node dissection: clinical and financial implications

2015

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Background Enhanced recovery after surgery (ERAS) protocols aim to improve patient care, reduce complication rates and shorten hospital stay following surgery. The key elements of these protocols include preoperative counselling, standardized analgesia and early mobilization. We present our experience in applying ERAS pathway for skin cancer patients requiring regional lymph node dissection (LND). Our protocol streamlines from the initial clinic consultation and perioperative management to safe discharge and regular clinic follow-up. Methods Prospective data collection of 100 consecutive patients who underwent LND, performed by the senior author, was done. Data included patient demographics, initial diagnosis, initial clinic appointment, surgery date, discharge date, number of follow-up clinics and complications. Our results were compared to the results of an audit of 50 consecutive patients managed in our department prior to the introduction of the presented protocol. ResultsOur ERAS pathway resulted in a shorter hospital stay and fewer complication rates. Our patients were discharged, with drains in situ. Our mean length of stay (LOS) for axillary, inguinal and neck LND was 1.18, 2 and 4.1 days, respectively. The overall LOS was 2.4 versus 9.5 days in the audited previous practice. Our complication rate was 50 % less (P= 0.002). This also resulted in substantial financial savings. Conclusions ERAS protocol for skin cancer patients requiring LND is based on multi-disciplinary team (MDT) approach. It has proven to be an efficient and safe streamlined pathway from consultation to discharge, with shorter hospital stay and satisfactory clinical outcomes as well as substantial financial savings that could be recruited in other services. Level of Evidence: Level III, risk/prognostic study.

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“…Almost all patients from the test group had an excellent alertness OAA/S score already on the day of the surgical procedure. Therefore, we believe that a continuous infusion of a local anaesthetic represents a very good pain management option for patients who underwent axillary lymph node dissection and are thus treated as a day case, which has already become a standard of care in some hospitals, for example in the Memorial Sloan-Kettering Cancer Centre in New York 30. Painless postoperative patient management and a shorter hospital stay are an essential part of a patient-friendly treatment.…”

Section: Discussionmentioning

confidence: 99%

Comparison of continuous local anaesthetic and systemic pain treatment after axillary lymphadenectomy in breast carcinoma patients – a prospective randomized study

Strazisar

Bešič²

2013

Radiology and Oncology

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BackgroundAcute pain after axillary lymphadenectomy is often related mainly to axillary surgery. The aim of the prospective randomized study was to find out if continuous wound infusion of local anaesthetic reduces postoperative pain, consumption of opioids and the incidence of chronic pain compared to the standard intravenous piritramide analgesia after axillary lymphadenectomy in breast carcinoma patients.MethodsAltogether 60 patients were enrolled in the prospective randomized study; half in wound infusion of local anaesthetic and half in the standard (piritramide) group.ResultsIn the recovery room and on the first day after surgical procedure, the wound infusion of local anaesthetic group reported less acute and chronic pain, a lower consumption of piritramide and metoclopramide, but their alertness after the surgical procedure was higher compared to the standard group.ConclusionsAfter axillary lymphadenectomy in breast carcinoma patients, wound infusion of local anaesthetic reduces acute pain and enables reduced opioid consumption, resulting in less postoperative sedation and a reduced need for antiemetic drugs. After wound infusion of local anaesthetic there is a statistical trend for reduction of chronic pain.

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Enhancing the clinical pathway for patients undergoing axillary lymph node dissection

Cited by 15 publications

References 6 publications

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

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

Introducing an enhanced recovery after surgery (ERAS) pathway for regional lymph node dissection: clinical and financial implications

Comparison of continuous local anaesthetic and systemic pain treatment after axillary lymphadenectomy in breast carcinoma patients – a prospective randomized study

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