Outcomes of the same‐day discharge following mastectomy before, during and after COVID‐19 pandemic

Abstract

Background and Objectives The majority of patients undergoing mastectomy before the COVID‐19 pandemic were admitted for 23‐h observation to the hospital. Indications for observation included drain care education, pain control and observation for possible early surgical complications. This study compared the rates of outpatient mastectomy before, during, and after the COVID‐19 pandemic and indirectly evaluated the safety of same‐day discharge. Methods We retrospectively analyzed patients undergoing mastectomy using Current Procedural Terminology code 19303. Results A total of 357 patients were included: 113 were treated pre‐COVID‐19, 82 patients during COVID‐19 and 162 post‐COVID‐19. The rate of outpatient mastectomies tripled during the pandemic from 17% to 51% (p < 0.001); after the pandemic remain high at 48%. The rate of bilateral mastectomies decreased during the pandemic to 30% from 48% prepandemic (p = 0.015). Pectoralis muscle block utilization increased during the COVID‐19 period from 36% to 59% (p = 0.002). No difference in complication rates, including surgical site infections, hematomas, and readmissions, pre and during COVID. Conclusions The rate of outpatient mastectomy increased during the COVID‐19 pandemic. During this timeframe, perioperative complications did not increase, suggesting the safety of this practice. After the pandemic, the rate of outpatient mastectomy continued to be significantly higher than pre‐COVID.

Lasting Impacts of the COVID-19 Pandemic on Breast Cancer Diagnosis and Treatment in the United States

“… 21 A recent study published in January 2023 looked at outcomes of same-day discharge mastectomy pre- and post-COVID19 pandemic and showed no difference in complication rates including hematomas, readmissions or surgical site infections. 20 These studies support the continued effort of enhanced recovery after surgery practices which will likely continue to grow in both the number and types of procedures that will be performed as an outpatient.…”

“…Given the focus on minimizing exposure of patients and healthcare workers to the virus and shortage of PPE many centers shifted from routine 23-hour observation or admission of patients after mastectomy to same day discharge. 20 This was not only for patients undergoing total mastectomy but also those that underwent mastectomy with immediate reconstruction. Although the COVID-19 pandemic placed unprecedented emphasis on outpatient breast cancer surgery, the initial shift to home recovery after mastectomy began in the early 2000s with literature supporting that home recovery is a safe option for appropriately selected patients without increased risk of complications.…”

Association between COVID-19 and Postoperative Neurological Complications and Antipsychotic Medication Use after Cancer Surgery: A Retrospective Study

“…In addition, we included a cohort of patients who were mainly recovering or fully recovered from COVID-19 and undergoing elective oncologic resections at a high-volume comprehensive cancer center which may not be representative or generalizable across all settings. Although a recent study reported that the rate of postoperative complications is not increased in patients undergoing mastectomy in the ambulatory setting, our results cannot be generalized to oncological patients undergoing same-day surgery [ 39 ]. Second, we excluded patients undergoing emergency surgery or those with an active infection whose risk of postoperative delirium could have been higher than those recovering from the disease [ 40 ].…”

Safety and factors affecting same‐day discharge following mastectomy and immediate alloplastic reconstruction

“…A comprehensive systematic review of these changes was conducted by Hemal and colleagues, who found a temporary reduction in autologous reconstruction, increased use of DTI over TE‐based reconstruction, emphasis on expedited discharge postoperatively, and no significant increase in complications 12 . Indeed, a comparison of protocols before, during, and after the COVID‐19 pandemic among 357 patients done by Olimpiadi et al revealed a tripling of outpatient mastectomies and increased use of pectoralis muscle blocks 13 . Among alloplastic reconstruction in particular, COVID‐19 prompted an increase in delayed reconstruction and increased outpatient surgeries 14 …”

“…T A B L E 5 Indications for admission among Group 2b. 13 Among alloplastic reconstruction in particular, COVID-19 prompted an increase in delayed reconstruction and increased outpatient surgeries. 14 Analysis of complications and outcomes among smaller patient cohorts showed no difference between patients who underwent same-day surgery versus those admitted for observation, [15][16][17][18] which has been supported by aggregate data from larger databases and systematic reviews.…”