Outcomes of a same day discharge protocol in patients undergoing mastectomy and implant reconstruction.
Publication Title
World journal of surgery
Document Type
Article
Publication Date
1-1-2024
Keywords
washington; swedish; Humans; Mastectomy; Retrospective Studies; Female; Middle Aged; Patient Discharge; Patient Readmission; Length of Stay; Breast Neoplasms; Adult; Mammaplasty; Aged; Treatment Outcome; Ambulatory Surgical Procedures; Clinical Protocols; Breast Implantation
Abstract
BACKGROUND: Finite hospital resources has required a closer look at resource allocation. This has prompted a shift toward same day surgeries and a focus on reducing hospital readmissions. Following the institution of a same day discharge protocol for mastectomy and mastectomy with immediate reconstruction, we sought to assess differences in the length of stay and readmission rates.
METHODS: This retrospective review evaluates all cases of mastectomy with or without immediate reconstruction performed at a single high-volume center between June 2019 and March 2021. Average length of stay, 30-day readmission rates, Anesthesia Society Assessment class, and type of immediate reconstruction were assessed. Autologous reconstructions were excluded.
RESULTS: A total of 413 patients underwent mastectomy with or without reconstruction (n = 148 pre protocol and n = 265 during protocol) between June 2019 and March 2021. Of those 413 patients, 180 underwent reconstruction (n = 62 pre protocol and n = 118 during protocol). The average length of stay after mastectomy following the implementation of the same day discharge protocol was decreased at 0.6 days (n = 265) compared to preimplementation at 1.02 days (n = 148), p < 0.001. The 30-day readmission rate was not significant between the groups, p = 0.13. A total of 180 patients underwent immediate reconstruction after mastectomy. The average length of stay after mastectomy with immediate reconstruction following implementation of the same day discharge protocol was shorter than preimplementation at 1.05 days preimplementation (n = 62) versus 0.58 days following implementation (n = 118), p < 0.001; this finding was significant for both prepectoral and subpectoral implants, p < 0.001. There was no significant difference in 30-day readmission rates between the groups with immediate reconstruction, p = 0.34.
CONCLUSION: Same day discharge for mastectomy with reconstruction is as safe as the more widely recognized same day discharge practice for patients with mastectomy alone.
Area of Special Interest
Women & Children
Specialty/Research Institute
Hospital Medicine
Specialty/Research Institute
Plastic Surgery
Specialty/Research Institute
Surgery
DOI
10.1002/wjs.12006
