The Quest for Outpatient Mastectomy in COVID-19 Era: Barriers and Facilitators

Abstract

Background. The rate of inpatient mastectomies remains high despite multiple studies reporting favourably on outpatient mastectomies. Outpatient mastectomies do not compromise quality of patient care and are more efficient than inpatient care. The objective of this study was to evaluate the feasibility of outpatient mastectomy. Materials and Methods. Implementation of an outpatient mastectomy program was evaluated in a retrospective study. All patients who underwent mastectomy between January 2019 and September 2021 were included. Results. 213 patients were enrolled in the study: 62.4% (n = 133) outpatient mastectomies versus 37.6% (n = 80) inpatient mastectomies. A steady rise in outpatient mastectomies was observed over time. The second quarter of 2020, coinciding with the first COVID-19 wave, showed a peak in outpatient mastectomies. The only significant barrier to outpatient mastectomy proved to be bilateral mastectomy. Unplanned return to care was observed in 27.8% of the outpatient versus 36.3% of the inpatient mastectomies ( P = 0.198 ); the reason for unplanned return of care was similar in both groups. Conclusions. Outpatient mastectomy is shown to be feasible and safe with a steady increase during the study period. A barrier to outpatient mastectomy was bilateral mastectomy. Incidence of unplanned return to care or complications did not differ significantly between the outpatient and inpatient cohorts.

Patient Experience and Clinical Outcomes after Same-day Outpatient Mastectomy and Immediate Breast Reconstruction Protocol during the Global Pandemic

“… 29 Cordeiro et al (2016) reported an average estimated saving of $4000 per patient with the transition from an overnight stay to same-day discharge after major breast cancer surgery. 20 , 25 Factors that may be considered potential barriers to same-day discharge in major breast cancer surgery included bilateral procedures, 30 obesity, and age. 25 Failed same-day discharge may be attributed to postoperative nausea, vomiting, and inadequate pain control.…”