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

Abstract

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.

Awakening Characteristics and Recovery of Cognitive Function in Patients Undergoing Short Surgical Procedures: Comparison Between Desflurane and Propofol

“…Our study showed faster awakening time with Desflurane than Propofol which is similar to previously published literature [1,2,4,10,19,20]. However, a study conducted by Larsen et al [8] where only propofol group patients received Remifentanil, showed faster awakening time in Propofol when compared to Desflurane (3.7±2.6 min vs. 6.2±2.6 min).…”

Drainless Parotidectomy Using Tissue Fibrin Sealant -- A Case-Control Study

“…Concerns of leaving the parotid bed undrained are probably based on the rich blood supply and secretive nature of the gland. Interestingly, use of FS was feasible and safe in drainless mastectomy, which also involves a secretive gland rich in fat tissue [ 15 ]. Our study's result support the report by Congilio et al [ 16 ] on successful drainless outpatient parotidectomy in a selected group of patients.…”

Use of polysaccharide hemostatic agent (HaemoCer™) in breast cancer surgery to reduce postoperative complications: A randomised controlled trial

“… 6 Specifically the effect of fibrin sealant containing human thrombin or combined hemostatic powder containing collagen, thrombin and chondroitin sulfate has been evaluated in the past, resulting in early drainage removal and increased day‐case surgery. 15 , 17 , 18 Furthermore, natural polysaccharide hemostatic agents have as well shown high biocompatibility and good hemostatic characteristics, 19 but there is a paucity of data regarding the application during breast‐conserving surgery and its effect. Hence, we aimed to evaluate the hemostatic performance of polysaccharide agents in breast‐conserving surgery with a prospective randomised‐controlled study.…”