Incidence of Complications in Outpatient Mastectomy with Immediate Reconstruction

Simpson, Scott A.; Ying, B; Ross, Lisa; Friedman, David J.; Quraishi, Mohammed I.; Rizvi, Avez A.; Bernik, Stephanie F.

doi:10.1016/j.jamcollsurg.2007.03.030

Cited by 27 publications

(21 citation statements)

References 13 publications

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“…In a study by Simpson et al, of 29 outpatient mastectomies with immediate reconstruction, only 1 (3 %) required a subsequent hospitalization for bleeding. 26 The overall complication rate was 24 % with three seromas, two cases of cellulitis, and one hematoma; most complications were managed in the outpatient office. This study’s infection rate falls within reported infection rates (range 1–35 %) after inpatient postmastectomy reconstruction.…”

Section: Discussionmentioning

confidence: 96%

Utilization of Mastectomy and Reconstruction in the Outpatient Setting

Kruper

Henderson

et al. 2012

Ann Surg Oncol

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Background Reconstruction rates after mastectomy have been reported to range from 25–40 %; however, most studies have focused on patients treated in an inpatient setting. We sought to determine the utilization of outpatient mastectomy and use of breast reconstruction in Southern California. Methods Postmastectomy reconstruction rates were determined from the California Office of Statewide Health Planning and Development database from 2006–2009 using CPT codes and similarly from an inpatient database using ICD-9 codes. Reconstruction rates were compared between the inpatient and outpatient setting. For the outpatient setting, univariate and multivariate odds ratios with 95 % confidence intervals were estimated for relative odds of immediate reconstruction versus mastectomy alone. Results The percentage of patients undergoing outpatient mastectomy ranged from 20.4 to 23.9 % of the total number of all patients undergoing mastectomy. Whereas immediate inpatient reconstruction increased from 29.2 to 41.6 % (overall rate 35.5 %), the proportion of outpatients undergoing reconstruction only increased from 7.7 to 10.3 % (overall rate 9.1 %). Similar to the inpatient setting, in multivariate analysis, age, insurance status, race/ethnicity, and type of hospital were significantly associated with the use of reconstruction in the outpatient setting. Conclusions A substantial number of patients undergo outpatient mastectomy with low rates of reconstruction. Although the choice of an outpatient mastectomy may certainly represent a selection bias for those not choosing reconstruction, an increase in the use of outpatient mastectomy may result in decreases in the use of post-mastectomy reconstruction.

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Section: Discussionmentioning

confidence: 96%

Utilization of Mastectomy and Reconstruction in the Outpatient Setting

Kruper

Henderson

et al. 2012

Ann Surg Oncol

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“…4 Same day discharge for mastectomy patients mitigates potential harms and costs associated with an inpatient admission, conserves valuable hospital resources, and affords patients postoperative recovery in the comfort of their own homes, without any increase in complication rates. Despite multiple retrospective series concluding that outpatient mastectomy is safe 5 , 6 , 7 , 8 , adoption of this practice varies nationwide. 4 , 9 , 10 …”

Section: Introductionmentioning

confidence: 99%

“…with an inpatient admission, conserves valuable hospital resources, and affords patients postoperative recovery in the comfort of their own homes without any increase in complication rates. Despite multiple retrospective series concluding that outpatient mastectomy is safe, [5][6][7][8] adoption of this practice varies nationwide. 4,9,10 We previously published our organization's experience with the implementation of the Surgical Home Recovery (SHR) initiative, which enabled the rapid transition from predominantly inpatient to predominantly outpatient mastectomies.…”

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confidence: 99%

Outpatient Mastectomy: Factors Influencing Patient Selection and Predictors of Return to Care

Vuong

Dusendang

Chang

et al. 2021

Journal of the American College of Surgeons

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BACKGROUND: After implementation of the Surgical Home Recovery (SHR) initiative for mastectomy within a large, integrated health delivery system, most patients are discharged on the day of the procedure. We sought to identify predictors of SHR and unplanned return to care (RTC). STUDY DESIGN: Mastectomy cases with and without reconstruction from October 2017 to August 2019 were analyzed. Patient characteristics, operative variables, and multimodal pain management were compared between admitted patients and SHR patients using logistic regression. We identified predictors of RTC in SHR patients, defined as 7-day readmission, reoperation, or emergency department visit. RESULTS: Of 2,648 mastectomies, 1,689 (64%) were outpatient procedures and the mean age of patients was 58.5 years. Predictors of SHR included perioperative IV acetaminophen (odds ratio [OR] 1.59; 95% CI, 1.28 to 1.97), perioperative opiates (OR 1.47; 95% CI, 1.06 to 2.02), and operation performed by a high-volume breast surgeon (OR 2.12; 95% CI, 1.42 to 3.18). Bilateral mastectomies (OR 0.70; 95% CI, 0.54 to 0.91), immediate reconstruction (OR 0.52; 95% CI, 0.39 to 0.70), and American Society of Anesthesiologists class 3 to 4 (OR 0.69; 95% CI, 0.54 to 0.87) decreased the odds of SHR. Of SHR patients, 111 of 1,689 patients (7%) experienced RTC. Patients with American Society of Anesthesiologists class 3 to 4 (OR 2.01; 95% CI, 1.29 to 3.14) and African American race (OR 2.30; 95% CI, 1.38 to 4.91) were more likely to RTC; receiving IV acetaminophen (OR 0.56; 95% CI, 0.35 to 0.88) and filling an opiate prescription (OR 0.51; 95% CI, 0.34 to 0.77) decreased the odds of RTC. CONCLUSIONS: Surgeon volume and multimodal pain medication increased the odds of SHR. Within the SHR group, American Society of Anesthesiologists Class 3 to 4 and African American patients increased the likelihood of RTC. This study helps optimize patient selection and perioperative practice for successful SHR.

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“…Other studies, such as that by Alderman et al (2), have described similar rates of complications, with 31.6 percent for the whole set of techniques and 46 percent when considering only IBR with a tissue expander. Other authors have reported diverse rates, from less than 10 percent (7) to around 20 percent (3;10;14;17;20), 30 percent (26), 40 percent (11;24), and even close to 50 percent (13;19;23).…”

Section: Discussionmentioning

confidence: 99%