Randomised controlled trial of effects of early discharge after surgery for breast cancer

Abstract

Objective To determine the effect of early discharge from hospital after surgery for breast cancer on physical and psychological illness. Design Randomised controlled trial comparing discharge two days after surgery (before removal of drain) with standard management (discharge after removal of drain). Setting Regional breast unit. Subjects 100 women with early breast cancer undergoing mastectomy and axillary node clearance (20) or breast conservation surgery (80). Main outcome measures Physical illness (infection, seroma formation, shoulder movement) and psychological illness (checklist of concerns, Rotterdam symptom questionnaire, hospital anxiety and depression scale) preoperatively and at one month and three months postoperatively. Results Women discharged early had greater shoulder movement (odds ratio 0.28 (95% confidence interval 0.08 to 0.95); P = 0.042) and less wound pain (odds ratio 0.28 (0.10 to 0.79); P = 0.016) three months after surgery compared with women given standard management. One month after surgery scores were significantly lower on the Rotterdam symptom questionnaire in patients who were discharged early (ratio of geometric mean scores 0.73 (0.55 to 0.98); P = 0.035), but rates of psychological illness generally did not differ between groups. Conclusions Increased rates of physical or psychological illness did not result from early discharge after surgery for breast cancer. This policy can be recommended for patients with support at home.

Patient, carer and health service outcomes of nurse-led early discharge after breast cancer surgery: a randomised controlled trial

“…Although it is possible to discharge patients early without a wound drain in situ (Purushotham et al, 2002), this has not become standard practice. This trial provides further evidence that early discharge for patients recovering from axillary clearance for breast cancer is safe (Bonnema et al, 1998a;Bundred et al, 1998;Horgan et al, 2000). In addition, this study provides novel data on patients, the applicability of early discharge to an unselected population of patients with breast cancer, and the benefits and burdens of early discharge or conventional stay for carers and primary or secondary health care services.…”

“…Randomised controlled trials carried out in Holland (Bonnema et al, 1998a) and England (Bundred et al, 1998;Horgan et al, 2000) have suggested that early discharge following axillary clearance has no adverse effect on physical or psychological outcome, and is acceptable to patients. There are indications that early discharge (with drains in situ) may enhance shoulder movement (Bundred et al, 1998), reduce wound pain (Bundred et al, 1998) and improve family support (Bonnema et al, 1998a), and it has been assumed that financial benefits to the Health Service will ensue.…”

“…Studies have so far used limited questions to establish patient satisfaction with care, and none have employed breast cancer-specific tools to investigate the impact of hospitalisation or early discharge on quality of life. Moreover, almost two-thirds of the potential population of patients may be excluded on the grounds of geographical or social ineligibility (Bundred et al, 1998), thus making it difficult to estimate how many women facing axillary clearance surgery would, in reality, opt for early discharge if it was offered.…”

Hospital Stay related to TNM-stage and the surgical procedure in primary breast cancer

“…There are studies indicating that well-informed patients who received good quality care are satisfied even when MLOS is cut radically (13,14) This would suggest that well-managed rationalization is not in opposition to the patient's needs and interests.…”

Factors Affecting the Postsurgical Length of Hospital Stay in Patients with Breast Cancer

“…Bundredet al (22) found no negative effect of early discharge on physical and psychological illness and advised early discharge for patients who were provided with informal care at home. In addition,the advantages of a short LOS includes less workload on staff, savings on hospital charges, reduction in waiting lists, and shift from expensive hospital care to cheaper home care (23).…”