Mastectomy and Prepectoral Reconstruction in an Ambulatory Surgery Center Reduces Major Infectious Complication Rates

Abstract

Background: Mastectomy and implant-based reconstruction is typically performed in a hospital setting (HS) with overnight admission. The aim of this study was to evaluate postoperative complications and outcomes with same-day discharge from an ambulatory surgery center (ASC) compared with the same surgery performed in the HS. Methods: Patients who underwent mastectomy and immediate prepectoral tissue expander reconstruction were included in this retrospective study. Surgery was performed in an ASC with same-day discharge or the HS with overnight observation or same-day discharge. Patient demographics, operative details, outcomes, complications, and patient satisfaction were compared. Results: One hundred six women (183 breasts) underwent surgery in the HS, and 103 women (177 breasts) had their surgery in an ASC between August 2014 and September 2019. Demographics, comorbidities, and operative details were similar. Although there was no difference in the rates of most major complications, infectious complications requiring operative intervention were less frequent in the ASC [2.3% (n = 4) versus 11.5% (n = 21); P = 0.001]. Patient satisfaction, evaluated with a 5-point Likert scale, was higher in the ASC. Conclusions: Mastectomy and prepectoral reconstruction in an ASC is a safe alternative to the standard approach of performing this procedure in the HS. Although the rates of most surgical complications are similar between the HS and ASC, we have found a significantly reduced rate of major infectious complications requiring surgical intervention in the ASC which reduces overall cost and patient morbidity. Finally, patient satisfaction was higher in the ASC compared with the HS.

Hospital-Based Same-Day Compared to Overnight-Stay Mastectomy: An American College of Surgeons National Surgical Quality Improvement Program Analysis

“…The pandemic forced many institutions to re-examine their approach and criteria for patients who truly require an overnight hospital stay, and this effort increased interest in developing and implementing SDM protocols that minimize the need for an overnight hospital stay. [12][13][14][15][16] However, whether the safety of SDM demonstrated at single integrated health care centers is generalizable to other institutions at the national level remains unclear. The primary purpose of this study was to examine 30-day outcomes of SDM using a large national database.…”

Breast Surgery in the Time of Global Pandemic: Benefits of Same-Day Surgery for Breast Cancer Patients Undergoing Mastectomy with Immediate Reconstruction during COVID-19

“…I am in agreement with these findings and recently published results for 106 consecutive patients (183 breasts) who underwent mastectomy and immediate implant-based reconstruction and same-day discharge from my institution’s ambulatory surgery center. 3 My experience started in July of 2017 and is currently ongoing, now with more than 200 patients undergoing same-day surgery. I utilize preoperative celecoxib, gabapentin, and acetaminophen 4 and perform intraoperative pectoral nerve blocks to minimize narcotic requirements and to facilitate same-day surgery.…”

Reply: Breast Surgery in the Time of Global Pandemic: Benefits of Same-Day Surgery for Breast Cancer Patients Undergoing Mastectomy with Immediate Reconstruction during COVID-19

“…In his study, he emphasizes data demonstrating reduced infection rates to infer cost-effectiveness of same-day surgery for mastectomy. 2 While this is a notable assumption, it is not direct evidence. With access to billing information for cohorts that have been either discharged from same-day surgery or admitted following mastectomy, we are conducting a thorough cost analysis of the procedures.…”

“…Thorough research into the ideal characteristics of patients and resources required to appropriately educate and support same-day surgery for mastectomy is critical. Nonetheless, studies such as Dr. Schwartz’s 2 and ours 1 promote the transition to same-day surgery as a means of improved quality, satisfaction, and cost of reconstruction for breast cancer patients.…”