Surgical Factors, Rather Than Patient Characteristics, Predict Inpatient vs Outpatient Mastectomy for Breast Cancer Patients

Cao, Lifen; Perez, Jaime; Schlick, Kayla; Simpson, Ashley; Freyvogel, Mary; Li, Pamela; Rock, Lisa; Snider, A. Rebecca; Shenk, Robert; Miller, Megan E.

doi:10.1016/j.jamcollsurg.2021.07.036

Journal of the American College of Surgeons

2021

DOI: 10.1016/j.jamcollsurg.2021.07.036

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Surgical Factors, Rather Than Patient Characteristics, Predict Inpatient vs Outpatient Mastectomy for Breast Cancer Patients

Lifen Cao

Jaime Perez

Kayla Schlick

et al.

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“… 9 – 12 There are also data suggesting that differences in surgeon practice patterns, rather than differences in patient demographics or comorbidities, may be driving this practice. 13 Moreover, a review article by the American Society of Breast Surgeons was recently released describing important factors to consider when starting a same-day mastectomy program. 14 However, the factors listed in this review were from quantitative analyses of same-day mastectomy outcomes.…”

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Surgeon Perspectives on Determinants of Same-Day Mastectomy: A Roadmap for Implementing Change

et al. 2022

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Background Same-day discharge after mastectomy without immediate reconstruction (MwoR) has been shown to be safe, with improved patient satisfaction when compared with patients discharged 1 or more days after surgery. Nevertheless, only 16% of patients undergoing MwoR in Michigan are discharged on the day of surgery, with significant variation between facilities (3–88%). Our objective was to explore determinants of same-day discharge and offer strategies for broader implementation of this practice. Methods We conducted semi-structured interviews with surgeons performing MwoR across the state of Michigan. Recruitment utilized purposeful and snowball sampling methods. The Tailored Implementation in Chronic Disease (TICD) framework was used to inform the creation of the interview guide. Interviews were transcribed and then analyzed using directed content analysis guided by the TICD framework. Salient determinants were organized into patient, provider, and system-level factors. Results Participants ( n = 26) included general surgeons, breast surgeons, and surgical oncologists. Most surgeons ( n = 18, 69%) reported that they discharged fewer than 60% of patients the same day after MwoR. The most common barriers included patient knowledge at the patient level; awareness of evidence, surgeon dogma, and peer influence at the provider level; and team processes and operating room logistics at the system level. Conclusion We identified surgeon-defined determinants of same-day discharge after MwoR. For the identified barriers, potential implementation strategies could include incorporation of preoperative drain teachings for patients, utilizing consensus statements and opinion leaders to disseminate evidence supporting same-day mastectomies, and conducting workshops with relevant stakeholders to establish consistent facility practice patterns among surgical teams. Supplementary Information The online version contains supplementary material available at 10.1245/s10434-022-12934-x.

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Surgeon Perspectives on Determinants of Same-Day Mastectomy: A Roadmap for Implementing Change

et al. 2022

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Surgical Factors, Rather Than Patient Characteristics, Predict Inpatient vs Outpatient Mastectomy for Breast Cancer Patients

Cited by 1 publication

References 0 publications

Surgeon Perspectives on Determinants of Same-Day Mastectomy: A Roadmap for Implementing Change

Surgeon Perspectives on Determinants of Same-Day Mastectomy: A Roadmap for Implementing Change

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