The Safety of Same-day Discharge after Immediate Alloplastic Breast Reconstruction: A Systematic Review

Abstract

Background: Implant-based breast reconstruction can be accomplished in a variety of ways and can result in vastly different postoperative experiences for patients. The COVID-19 pandemic and recent trends have resulted in a shift toward outpatient management of these patients. Methods: A systematic review of PubMed and Embase databases was conducted. A total of 1328 articles were identified on initial search, and after several rounds of review, a total of four met inclusion and exclusion criteria. Manuscripts were included if postmastectomy alloplastic breast reconstruction was performed, and there was documentation of same-day discharge. This cohort of patients was compared with traditional, planned overnight admission cohorts found in the literature. Objective data compared between groups included preoperative patient factors and postoperative complication rates. Results: Four studies representing data on a total of 574 patients were included: 289 were same-day discharge and 285 were overnight admission. Patient characteristics of body mass index, radiation, smoking, and bilateral procedures were comparable. Tissue expanders were used more frequently than implants in both cohorts. The rate of overall complications was 33% for same-day discharge and 34% for overnight admission. Rates of major and minor complications, including infection, seroma, and hematoma, were similar. There was no increase in reoperations or readmissions reported in any of the studies. Conclusions: Same-day discharge after mastectomy with immediate alloplastic reconstruction is a safe approach to treatment in both the ambulatory and hospital setting. There are comparable rates of common complications such as infection, seroma, and hematoma, with no increase in readmission or reoperation.

Enhanced Recovery After Surgery Protocol Allows Safe Same-Day Discharge in Expander Based and Oncoplastic Breast Reconstruction

“…A recent systematic review with a total of 285 same-day discharge patients found that ERAS protocols after immediate alloplastic breast reconstruction had no difference in overall complication rates, including hematomas, between same-day discharge and overnight admission patients. 19 In our study, only 1 TE-IBR patient and 1 oncoplastic breast reconstruction patient developed postoperative hematomas, which aligns with findings reported in the literature. With over a year's worth of same-day discharge patients, we can confidently demonstrate that there is no change in hematoma rates and subsequent outcomes.…”

“…Therefore, surgeons may be hesitant to discharge their patients home the day of surgery because of the risk of forming a hematoma in the immediate postoperative period and delaying treatment. A recent systematic review with a total of 285 same-day discharge patients found that ERAS protocols after immediate alloplastic breast reconstruction had no difference in overall complication rates, including hematomas, between same-day discharge and overnight admission patients 19 . In our study, only 1 TE-IBR patient and 1 oncoplastic breast reconstruction patient developed postoperative hematomas, which aligns with findings reported in the literature.…”

Value of Ambulatory Modified Radical Mastectomy

“… 29 – 31 Mastectomy with prosthetic reconstruction also has been shown to have equivalent readmission rates for ambulatory versus hospital-based procedures, and recent evidence from the COVID-19 pandemic has demonstrated that mastectomy with reconstruction can be performed on an ambulatory/outpatient basis without compromising safety or the patient experience. 7 , 15 , 16 , 18 , 32 – 34 Indeed, this ongoing experience demonstrates no difference in complications when mastectomy is performed in an ambulatory setting with or without prosthetic reconstruction.…”

“…Our findings differ from those of other studies in the surgical safety literature, which show that patient-level factors are indeed a significant predictor of postoperative readmissions. 18 , 19 In the breast surgical oncology literature, black race and higher American Society of Anesthesiologists class are shown to be significant factors of readmission. 5 In colorectal surgery, minority-serving hospitals have higher readmission rates than non-minority-serving hospitals, and patient-level factors account for 65 % of this difference.…”

Spotlight in Plastic Surgery: January 2023

“…By Marxen T, Shauly O, Losken A. Plast Reconstr Surg Glob Open 2022;10:e4448. 5 The authors present a systematic review assessing the safety of same-day patient discharge after immediate, alloplastic breast reconstruction. Four included studies provided data for a total of 574 patients.…”