Successful same day discharge after immediate post-mastectomy alloplastic breast reconstruction: A single tertiary centre retrospective audit

Oxley, Paul J.; McNeely, Carlyn; Janzen, Rhonda; Mian, Rizwan A.; Lee, Adrian T.; Murabit, Amera; Wang, Peiwei; McNeely, David

doi:10.1016/j.bjps.2020.01.018

Cited by 16 publications

(47 citation statements)

References 16 publications

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“…This is a critical component of the pathway in setting patients’ expectations that same-day discharge is the norm and not the exception. 28 When reassured, patient fears regarding infectious complications far supersede concerns over postoperative pain and nausea. Patients receive a surgical packet, including preoperative and postoperative instructions, drain care, pain management, prescriptions, and on-call provider contact numbers.…”

Section: Discussionmentioning

confidence: 99%

“…The single previous publication comparing immediate implant-based reconstruction in an ASC versus HS demonstrated no differences in complications. 28 However, this was a hospital-owned ASC and may have been run with similar protocols and procedures in place as the main hospital which might minimize differences in outcomes. Their infectious complication rates may have already been low, and a difference may have been difficult to detect between the 2 venues.…”

Section: Discussionmentioning

confidence: 99%

“…Although several reports in other surgical fields 24 – 27 have compared outcomes between ASCs and the HS, we are only aware of one similar publication by Oxley et al 28 in the field of immediate implant-based postmastectomy reconstruction, which demonstrated equivalent rates of complications and outcomes between the 2 venues. The feasibility of routinely performing mastectomy and immediate implant-based reconstruction with same-day discharge using an enhanced recovery protocol was established by Dumestre et al 10 in 2017.…”

Section: Introductionmentioning

confidence: 94%

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

Schwartz

2020

Plastic and Reconstructive Surgery - Global Open

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 94%

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

Schwartz

2020

Plastic and Reconstructive Surgery - Global Open

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“…Compared with hospital surgery, it can elevate the utilization of beds and the turnover rate, reduce medical expenses, and relieve the surgical treatment pressure to hospitals and the mental burden to the patients [4,5] . Therefore, day surgery module has be applied to the treatment for breast cancer, and studies have highlighted the safety of day surgery for breast cancer patients [6][7][8] .…”

Section: Introductionmentioning

confidence: 99%

“…Thus, the traditional view is that breast reconstruction is not suitable for day surgery. With enhanced recovery after surgery protocols showing significant benefit in major abdominal surgery, there has been a progressive trend to reduce inpatient stays for the majority of surgeries in recent history [5] . Therefore, under the pressure of COVID-19 global pandemic, in order to improve the resource utilization rate, some hospitals begin day surgery of breast reconstruction and believe it can safely be performed as same-day operations with no increased rates of postoperative morbidity [6,[14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Single-axillary-incision Endoscopic Nipple/Skin-sparing Mastectomy With Immediate Implant-based Breast Reconstruction of Day Surgery: Preliminary Results, Complications and Patient-reported Outcome From Preliminary 68 Procedures

Feng

Xie

Zhou

et al. 2022

Preprint

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Background and Aims The aim of this study is to present a day surgery protocol that minimizes resource utilization to enable hospitals to increase inpatient capacity and maximize treatment efficiency for breast cancer patients undergoing endoscopic nipple/skin-sparing mastectomy(E-N/SSM) with breast reconstruction through a single invisible axillary incision. Methods We retrospectively reviewed 60 consecutive patients(68 breasts) who underwent day surgery of E-N/SSM with implant-based reconstruction from July 2020 to November 2021 in West China Hospital. Postoperative complications, cost-effectiveness, and oncological safety were retrospectively analysed in patients. The SCAR-Q, BREAST-Q reconstruction module and photography were used to evaluate the breast satisfaction and quality of life(QoL). Results Sixty patients(68 breasts)with a mean age of 41.8±9.7 years were examined, with a median follow-up time of 6.5 months. Overall, the major complication rate and minor complication rate was 0% and 10.29%(7/68), respectively. Mean operation time was 123.94±24.26min(Surgeon A) and 180.64±16.68min (Surgeon B and C). The mean score of appearance scale of SCAR-Q was 60.9±12.7 at 3 months after operation. Breast satisfaction scores at 3 and 6 months after operation were significantly better than those before operation and at 1 month after operation (P<0.05); QoL scores (except for Physical Well-being: chest) at 6 months after operation were significantly better than those before operation(P<0.05). No local recurrence or distant metastasis developed. Conclusions Day surgery of E-N/SSM with immediate endoscopic breast reconstruction is safe and feasible in practice.

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

Ghosh,

Shakir,

Kuchta

et al. 2023

Journal of Surgical Oncology

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Background and ObjectivesPatients undergoing breast reconstruction following mastectomy are often admitted overnight. In 2020, our institution implemented a protocol change to discharge clinically stable patients immediately. In this study, we examine the safety of same‐day discharge following mastectomy and reconstruction.MethodsOur retrospective study included female adults undergoing mastectomy and immediate alloplastic reconstruction from August 2019 to January 2020, before implementation of the same‐day discharge protocol, and from March 2020 to September 2021, after the protocol implementation. Independent t‐test and chi‐square analysis was conducted to examine statistical differences.ResultsTwo hundred and eighty‐five patients were included. Forty‐two patients underwent reconstruction before the protocol change (Group 1) and 243 patients underwent reconstruction after the protocol change (Group 2). Group 2 had a greater percentage of prepectoral implant placement. There was no difference in demographics, complications, readmission, or reoperation. Within Group 2, 157 patients were discharged the same day (Group 2a) and 88 patients required overnight admission (Group 2b). Group 2b had higher body mass index, higher percentage of bilateral mastectomy, and larger mastectomy weights. Despite no differences in complications, Group 2b exhibited higher rates of requiring intravenous antibiotics and reoperation.ConclusionsPatients may be safely discharged the same day following mastectomy and alloplastic reconstruction without an increase in complications.

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Successful same day discharge after immediate post-mastectomy alloplastic breast reconstruction: A single tertiary centre retrospective audit

Cited by 16 publications

References 16 publications

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

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

Single-axillary-incision Endoscopic Nipple/Skin-sparing Mastectomy With Immediate Implant-based Breast Reconstruction of Day Surgery: Preliminary Results, Complications and Patient-reported Outcome From Preliminary 68 Procedures

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

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