Post-operative care and patient satisfaction after ambulatory surgery for breast cancer patients

Comparison of Outcomes Following Prepectoral and Subpectoral Implants for Breast Reconstruction: Systematic Review and Meta-Analysis

(1) Background: Implant-based breast reconstruction following mastectomy helps to restore quality of life while aiming at providing optimal cosmetic outcomes. Both prepectoral (PP) and subpectoral (SP) breast implants are widely used to fulfill these objectives. It is, however, unclear which approach offers stronger postoperative benefits. (2) Methods: We performed a systematic review of the literature through PubMed, Cochrane Library, and ResearchGate, following the PRISMA guidelines. Quantitative analysis for postoperative pain as the primary outcome was conducted. Secondary outcomes included patient satisfaction and postoperative complications such as seroma, implant loss, skin necrosis, wound infection, and hematoma. (3) Results: Nine articles involving 1119 patients were retrieved. Our results suggested increased postoperative pain after SP implants and significantly higher rates of seroma following PP implants (p < 0.05). Patient satisfaction was found to be similar between the two groups; however, the heterogeneity of measurement tools did not allow us to pool these results. The rates of implant loss, skin necrosis, wound infection, and hematoma showed no significant differences between the two cohorts. (4) Conclusion: Our data suggest that both implant placements are safe and effective methods for breast reconstruction following mastectomy. However, homogeneity in outcome measurements would allow one to provide stronger statistical results.

Postdischarge pain, nausea and patient satisfaction after diagnostic and breast-conserving ambulatory surgery for breast cancer: A cross-sectional study

BACKGROUND

The aims of this study were to assess first day postdischarge pain, nausea and patient satisfaction in ambulatory breast cancer surgical patients, after diagnostic and breast conserving procedures.

METHODS

A total of 781 women, aged 18-85 years were included in this prospective, cross-sectional study. All patients received standardized multimodal pain prophylaxis with paracetamol, COX-II inhibitor, dexamethasone and wound infiltration with local anaesthetics. Nausea prophylaxis was provided with ondansetron. Most patients received general anaesthesia with propofol and remifentanil. Data were collected using a validated questionnaire during telephone follow-up on the first postoperative day.

RESULTS

The response rate was 94.5%. NRS ≥ 4 was reported by 5.3% at rest, by 17% during activity and by 30.7% as the worst pain score. Young age was strongly associated with more pain both at rest, during activity and regarding worst pain since discharge. Postdischarge nausea was present in 17.8%, and vomiting in 1.2%. High pain score during activity and higher level of worst pain, were associated with nausea. There was no association between nausea and age, type of anaesthesia, surgical procedure or pain at rest. Patient satisfaction was high (97.8%-99.7%) regarding information, time for discharge and overall satisfaction.

CONCLUSION

Pain scores and incidence of nausea were generally low on the day after surgery. Young age was a strong predictor for postdischarge pain. A high worst pain score and high pain score during the activity were associated with postdischarge nausea. Patient satisfaction was high.

Same‐day mastectomy and axillary lymph node dissection is safe for most patients with breast cancer

Background and Objective

The aim of this study was to evaluate the safety of same‐day mastectomy, with or without a sentinel node biopsy (SNB) and/or axillary lymph node dissection (ALND).

Methods

In this retrospective study, we reviewed 913 consecutive women who underwent a simple mastectomy for breast cancer between the years 2014 and 2019 and were treated either with same‐day surgery (SDS) or an overnight stay (OS) regime. We reviewed all surgical complications, any unplanned return to care (RTC) and the rehospitalization rate for 30 postoperative days.

Results

A total of 259 patients (28%) were treated with SDS and 654 patients (72%) with an OS regime. There was no difference in RTC (odds ratio: 0.79 [95% confidence interval: 0.53–1.18], p = 0.26) or any major complications between the groups. None of the investigated subgroups, such as patients with previous neoadjuvant therapy, diabetes, obesity (up to a body mass index of 40 kg/m²), the American Society of Anaesthesiologist Class of 3, or elderly patients aged 75–84 years, showed an increased complication rate when treated with the SDS regime.

Conclusion

A same‐day simple mastectomy is safe with SNB and/or ALND. It can be performed safely for most patients with stable co‐morbidities.

Decreased postoperative pain and opioid use following prepectoral versus subpectoral breast reconstruction after mastectomy: A retrospective cohort study: Pain after pre- versus subpectoral reconstruction

BACKGROUND

Prepectoral (PP) breast reconstruction is now commonly performed and minimizes dissection of the pectoralis major muscle. Data are lacking comparing the immediate postoperative recovery of these patients as compared with traditional subpectoral (SP) breast reconstruction.

METHODS

From December 2015 to February 2017, 73 patients underwent PP prosthetic-based reconstruction at a single academic institution. PP cases were matched 1:1, by age and stage, to patients undergoing traditional SP reconstruction. Analysis of postoperative pain (visual analog scale) and opioid use (oral morphine equivalents, OME), was performed with both bi- and multivariate analyses. Additional outcomes explored included length of stay (LOS) and reconstructive intervention by plane of prosthetic reconstruction.

RESULTS

A total of 146 patients were included in the final cohort. PP reconstruction was associated with higher rates of direct-to-implant reconstruction (84.9% vs. 34.3%, p <0.001) and higher rates of initial prosthetic fill (401.53 mL vs. 280.88 mL, p<0.001). Patients undergoing PP reconstruction had significantly reduced postoperative pain (4.29 vs. 5.44, p<0.001) and in-hospital opioid use (62.63 mg OME vs. 98.84 mg OME, p = 0.03) compared with SP patients. This result remained in multivariate analysis for both pain (3.94 vs. 5.25, p<0.001) and opioid use (17.14 mg OME vs. 63.03 mg OME, p = 0.03). Additionally, patients undergoing PP reconstruction had significantly reduced overall LOS on multivariate analysis (21.36 vs. 26.28 h, p = 0.02).

CONCLUSION

Following mastectomy, PP breast reconstruction results in significantly reduced pain, opioid use, and hospital LOS compared with SP reconstruction.

Quality of life, anxiety, and postoperative complications of patients undergoing breast cancer surgery as ambulatory surgery compared to non-ambulatory surgery: A prospective non-randomized study

PURPOSE

According to the latest recommendations a minimally invasive approach should be used to manage breast cancer and a global policy for minimizing costs encourages shorter periods of hospitalization. The aim of this study was to investigate the impact of length of hospitalization on quality of life, anxiety and depression and postoperative complications.

METHODS

This is a prospective observational study of 412 female patients with breast cancer requiring a first mastectomy or lumpectomy to assess the impact of the length of hospitalization on quality of life (using the European Organization for Research and Treatment of Cancer Quality of Life QLQ30 and BR23 questionnaires) at postoperative day 14 (D+14), levels of anxiety at d-1 and D+1 (according to the Hospital Anxiety and Depression scale) and postoperative state at D+21.

RESULTS

Our study included 244 patients that had ambulatory surgery and 124 that had non-ambulatory surgery. Global health status was significantly better for ambulatory surgery patients (adjusted p-value=0.014). There were no significant differences between the two groups for levels of anxiety, pain, lymphoceles and postoperative complications. No cases of nausea and vomiting requiring medical treatment were reported for either group.

CONCLUSIONS

Breast cancer surgery can be performed using ambulatory surgery with no significant differences compared to non-ambulatory surgery in terms of quality of life, perioperative anxiety, and postoperative complications. Indeed, our study suggests that ambulatory surgery improves patient outcome. It should be determined whether the mode of hospitalization has any long-term impact on the patient, as a shorter hospitalization period would allow decreasing waiting times.

[Increase rate of ambulatory and management of the care path in breast cancer surgery]

OBJECTIVE

To describe practices and impact of ambulatory surgery rate, patient satisfaction after Nursing Support and Post Ambulatory Follow-up Device at Home at the Henri Becquerel Center (DIASPAD CHB) has been set up during surgical management in breast cancer.

METHOD

This is a prospective monocentric observational study carried out between January 2017 and December 2018. Patients eligible for the study should undergone breast cancer surgery without reconstruction. Outpatient care was possible if patients met medical, surgical, psychosocial and environmental criteria according to the characteristics of the foreseeable operating suites. We evaluated the progression of the ambulatory hospitalization rate since the DIASPAD CHB beginning and compared the use of this device in conventional and ambulatory hospitalization.

RESULTS

Since January 2017, 1312 patients undergone breast cancer surgery without reconstruction. After DIASPAD CHB implementation, ambulatory surgery rate increased from 46 % to 81.7 % for patients operated for breast cancer. The satisfaction rate of patients and nurses was 99 %.

CONCLUSION

DIASPAD CHB enabled ambulatory care to take a important share in surgical care in breast cancer by ensuring collaboration between healthcare professionals, anticipation, programming and coordination of care.

Short length of stay and the discharge process: Preparing breast cancer patients appropriately

OBJECTIVE

Breast cancer is the most common cancer among women worldwide, increasing the relevance of an efficient and successful care process. As length of stay (LOS) in the hospital decreases, patients' satisfaction with the LOS varies. We hypothesize that successful discharge planning can improve this evaluation.

METHODS

Data of 4,390 female breast cancer patients from a cross-sectional survey was analyzed. The data was collected in 2017 in 86 German hospitals. Logistic regressions were used to test hypotheses.

RESULTS

The majority of included patients rated their LOS as appropriate. However, patients who felt better prepared for discharge were less likely to rate their stay as too short. A longer stay in the hospital further decreased this likelihood. The effect of LOS was moderated by patient experiences with preparation for discharge.

CONCLUSION

As hospital LOS decreases, one challenge in allowing patients to feel sufficiently informed and ready to go home is the reduced time for face-to-face consultations. Our results indicate, however, that a strong and thorough discharge planning makes the actual number of days for LOS irrelevant for patient's rating of LOS.

PRACTICE IMPLICATIONS

The study results underscore the importance of ensuring the quality and thoroughness of the discharge process.

[Outpatient breast cancer surgery: Patient satisfaction study and the role of the attending physician]

OBJECTIVES

To evaluate the satisfaction of patients with breast cancer treated surgically in an outpatient setting and the role of the attending physician.

METHODS

This prospective satisfaction study focused on patients who had a breast cancer surgery as an outpatient procedure, between February and October 2018, at the CHU and Clinique Mutualiste chirurgicale de Saint-Étienne, Loire, France. The data were collected via a satisfaction survey, which was given to the patients during the postoperative visit.

RESULTS

One hundred and four patients were included. The most frequent surgery was partial mastectomy with sentinel lymph node (63.5%). On overall breast cancer surgery, 47.6% were performed on an outpatient basis. Ninety-seven percent of the patients were satisfied, 96.9% would have recommended this procedure to a friend and 47% could resume their daily activities as early as the second day. Among the patients, 16.2% would have preferred to stay on day more in hospital after the surgery. This preference was related to the complexity (P=0.035) and duration of the surgery (P=0.025), fatigue (P=0.03) and feeling of isolation (P=0.016). Among the patients, 25.5% saw their doctor for organic, psychological, administrative, monitoring and informational issues.

CONCLUSIONS

Outpatient breast cancer surgery seems safe and qualitative. Standardized procedures, relevant information about the outpatient procedure and specificities of this type of care, as well as the transmission of information with the attending physician are the keys to success.

[Breast cancer and outpatient surgery: State of play of the activity and assessment of patient satisfaction]

OBJECTIVE

The objective of this study was to evaluate an outpatient breast cancer surgery activity in our center and to collect the satisfaction of patient having benefited.

METHOD

Descriptive and retrospective study about patients who underwent surgery for breast cancer scheduled on ambulatory between March 2015 and March 2017. Patients' satisfaction was collected retrospectively by a questionnaire.

RESULTS

Six hundred and thirty-nine breast cancer surgeries were performed during the study period, of which 56.2% were scheduled for outpatient surgery: 33 axillary procedures (9.2%), 289 conservative surgeries (80.5%) and 37 radical surgeries (10.3%). Forty-nine patients initially managed on ambulatory had to be hospitalized on conventional service, representing a conversion rate of 13.6%. The main reason was the establishment of drainage (30.6%). The complication rate was 0.6% with 2 patients rehospitalized for hematoma requiring surgical revision. Of the 359 patients treated on ambulatory, 61% responded to the satisfaction questionnaire. Overall satisfaction was 96.3%. In addition, 68.3% of patients said they had seen a real benefit in this mode of care. After returning home, 59,8% of patients reported feeling no or low pain.

CONCLUSION

Outpatient management seems to be both safe and satisfying for breast cancer surgery. A better organization of patient going home is in progress in order to reduce rate of conversion.

Same-Day Surgery for Mastectomy Patients in Alberta: A Perioperative Care Pathway and Quality Improvement Initiative

BACKGROUND

Same-day surgery (SDS) following mastectomy is safe and well accepted. Overnight admission in patients fit for discharge is an inefficient use of health resources. In response to a national review highlighting SDS following mastectomy at 1.4% in Alberta, a perioperative pathway was conceived.

METHODS

The pathway was implemented across Alberta at 13 hospitals beginning in 2016. A steering committee was assembled, and clinical and administrative leads at each site were identified. Opportunities along the patient care experience whereby action could be taken to promote uptake of SDS were identified. Provincially branded support materials including presentations, order sets, and standard operating procedures were developed. Nurse educators provided in-service teaching such as standardized drain care and discharge teaching. Educational booklets, group classes, and online resources were developed for patients and families. An audit of SDS rates, unscheduled return to the emergency department (ED), and readmission rates was reported to teams quarterly, allowing for iterative modifications. Patient-reported experience measures (PREMs) were collected.

RESULTS

SDS following mastectomy increased from 1.7 to 47.8%, releasing an estimated 831 bed days per year. No differences in unexpected return to the ED or readmission to hospital existed between SDS patients and those admitted overnight. A total of 102 patients completed the PREM survey, of whom 90% felt "excellent or good" with the plan to go home, how to care for themselves once home, and who to contact should issues arise.

CONCLUSIONS

Implementation of a provincial perioperative pathway improved uptake of SDS following mastectomy and demonstrated favorable PREMs.

Major ambulatory surgery for the treatment of breast cancer: Factors conditioning conversion to conventional hospitalization

INTRODUCTION

The main step in curative treatment for breast cancer is surgery. Its use in an ambulatory setting can contribute towards more efficient healthcare, providing additional benefits for patients. In this study, we analyze the results obtained with this treatment method and identify factors related with conversion to hospitalization.

METHODS

Results were analyzed from the 206 surgeries performed for breast cancer in 2016, using three different methods: day surgery, overnight ambulatory (23h) and conventional hospitalization. The ambulatory success and conversion rates were calculated for the global sample and stratified, distinguishing between conservative surgery, mastectomy and axillary surgery. A univariate analysis was performed to identify the factors involved in conversion.

RESULTS

For the global sample, the ambulatory surgery rate was 61.2%, 16.5% conversions and a success rate of 83.4%. For conservative surgery, ambulatory, success and conversion rates were 78.8%, 88.6 and 11.4%, respectively. For mastectomies, the ambulatory rate was 28.6%, with 62.9% success and 37.1% conversions. The 11 axillary surgeries were performed as day surgeries. Factors associated with conversion were mastectomy vs. vs. conservative surgery and the appearance of postoperative complications.

CONCLUSIONS

Ambulatory surgery for the surgical treatment of breast cancer should be standard care. Optimized results require adequate patient selection and the performance of surgical technique that needs to be as careful and as conservative as possible.

[Mastectomy in ambulatory hospitalization or 24hours: Feasibility, satisfaction and preferences of the patients]

The aim of this study is to analyze the feasibility of ambulatory hospitalization or 24hours hospitalization for breast cancer treatment by mastectomy, as well as the satisfaction and the preferences of patients with regard to these ways of hospitalization.

METHODS

This observational retrospective study listed the patients operated for breast cancer who had required a mastectomy at the institute Paoli-Calmettes between the 1st of January 2013 and June 30th, 2015. A questionnaire of satisfaction was proposed to the patients regarding their mode of hospitalization.

RESULTS

One hundred and thirteen patients were included among which 29 were in the ambulatory group and 84 in the 24hours hospitalization group. The complications were represented by the rate of hematomas (3.5 %), which required a surgical resumption for two of the patients in the 24hours hospitalization group and for one patient in the ambulatory group (P=0.75). Patient's satisfaction rate was globally high: 72.7 % regardless of the mode of hospitalization (P=0.064).

CONCLUSION

The realization of mastectomy in ambulatory hospitalization seems feasible when the organization in pre- and postoperative is anticipated with a high degree of satisfaction of the patients. The psychological impact of this radical surgery seems to be a factor to be taken into account and requires a meticulous selection of the patients.

Same-Day Major Breast Cancer Surgery is Safe: An Analysis of Short-Term Outcomes Using NSQIP Data

INTRODUCTION

Most patients undergoing significant breast cancer surgery stay in hospital postoperatively. We sought to determine whether there was a difference in complication rates among patients undergoing same-day surgery (SDS) versus overnight or inpatient stay.

METHODS

Analysis of the American College of Surgeons, National Surgical Quality Improvement Program participant user files was performed. Patients with breast cancer undergoing mastectomy and/or axillary lymph node dissection between 2005 and 2012 were examined (high-risk comorbidities and concurrent surgery were excluded). Thirty-day postoperative morbidity was analyzed. Multivariable regression was performed identifying independent predictors of complications.

RESULTS

The final population consisted of 40,575 patients; 8365 had SDS, 23,252 stayed overnight, and 8958 stayed in hospital longer postoperatively. Those admitted to hospital were older, more obese, had higher American Society of Anesthesiology (ASA) class, medical comorbidities, or had bilateral surgery. The overall 30-day morbidity was 4.7 %. On univariate analysis, patients undergoing SDS had significantly lower 30-day morbidity (2.4 %) compared with overnight (3.9 %) or inpatient stay (8.8 %) (p < 0.0001). After controlling for the above differences between groups, patients staying overnight had a higher odds of postoperative complications [1.37, 95 % confidence interval (CI) 1.16-1.63, p = 0.004] and inpatients had over twice the odds of postoperative complications (2.65, 95 % CI 2.21-3.18, p < 0.0001) compared with SDS patients.

CONCLUSION

This is the largest study examining the safety of SDS for breast cancer. Complication rates were significantly higher for patients admitted to hospital postoperatively, even after controlling for baseline differences. These data suggest that, with appropriate selection, it is safe to perform major breast cancer surgery on a same-day basis.

[Can we enhance the one-day part in breast conservative surgery?]

INTRODUCTION

French national guidelines lead us to increase the part of one-day breast cancer conservative surgery. Our objective was to check if we can enhance our outpatient part and to identify solutions to improve our practices.

METHODS

From 01/01/2013 to 31/12/2014, we conducted a monocentric and retrospective register about all cases of breast conservative surgery (infiltrating or in situ carcinoma, atypical hyperplasia). The collected data were: patients' sociodemographic characteristics, modality of hospitalization, surgical characteristics, preoperative exams organization, complications and reasons for an absence of surgery planned in one-day modality. We compared the two groups (one-day and standard hospitalization).

RESULTS

We reported 324 surgeries of which 50.3% planned in one-day mode. The outpatient part increased from 39.8% in 2013 to 60.8% in 2014. There was no difference for postoperative complications between the two groups. We found a higher rate of outpatient for sentinel node axillary dissection in 2014 (65% versus 37% in 2013). We reported a rate of axillary dissection in one-day mode of 20%, of which 15% were drained. The proportion of patients unplanned in one-day mode without contraindications was reduced from 81% in 2013 to 57% for 2014.

DISCUSSION

Increasing our outpatient part in breast conservative surgery was possible. There are still efforts to do to reach the national goals of one-day conservative breast cancer surgery, especially for the organizational aspects that remains the main obstruction. The implementation of pathways specifically for outpatient in and out of the hospital could be an interesting solution.

Patients' perspective on day case breast surgery

BACKGROUND

This study assessed the views of patients undergoing breast surgery for breast cancer with a planned overnight stay, asking whether they would be happy to be discharged home on the same day of surgery.

METHODS

A structured questionnaire sent out in the 6 weeks following surgery was used to ascertain the patients' views.

RESULTS

The majority of patients undergoing mastectomy and axillary node clearance preferred an overnight stay, primarily for psychological reasons.

CONCLUSIONS

Patients undergoing breast-conserving surgery were more prepared to go home on the day of surgery.

Feasibility of Day Surgery in Patients With Breast Conservation and Sentinel Node Biopsy: A Randomized Controlled Trial

Background and Aims:

The aim of this study was to analyze feasibility of day surgery in breast cancer patients with breast conserving surgery and sentinel node biopsy.

Material and Methods:

The study was a randomized controlled trial comparing day surgery with one night hospital stay in breast cancer patients with breast conserving surgery and sentinel node biopsy. A total of 40 patients with ⩽3-cm tumor and clinically N0 were randomized to one night stay group and 38 patients to day surgery group. Within discharge, patients and their relatives were given questionnaires in order to evaluate their experience regarding the duration of hospital stay.

Results:

Randomized groups were similar regarding patient age and tumor stage. A total of 18 (47%) day surgery group patients were discharged the same day. The most common reason for overnight hospital stay was axillary clearance, 9 (24%). None of the patients in the day surgery group, but 2 patients in the overnight hospital stay group had re-operation due to complications. Perception and preference results were analyzed both according to randomization and actual treatment groups. Patients in both groups had rather similar experiences on the first postoperative day. Also, spouse’s or relative’s perception after discharge was similar in both groups.

Conclusion:

Day surgery was well received by the patients and their relatives. Day surgery appears as feasible in patients with breast conservation and sentinel node biopsy.

Axillary Padding without Drainage after Axillary Lymphadenectomy - a Prospective Study of 299 Patients with Early Breast Cancer

BACKGROUND: After lymphadenectomy for early breast cancer, seroma formation is a constant event requiring a suction drainage. This drainage is the strongest obstacle to reducing the hospital stay. Axillary padding without drainage appears to be a valuable option amid the various solutions for reducing the hospital stay. METHODS: We conducted a comparison between 114 patients with padding and 185 patients with drainage. Data were obtained from 2 successive prospective studies. RESULTS: The mean hospital stay was 2.4 days (range 1-4) in the padding group and 4.2 days (range 2-9) in the drainage group (p < 0.05). There were fewer needle aspirations for seroma in the padding group (8.8 vs. 23%, p < 0.05). At 6 weeks, only 28% (32/114) of the patients in the padding group reported pain versus 51% (94/185) in the drainage group. The mean pain intensity at 6 weeks was 3 and 4.3 respectively (p < 0.0001). CONCLUSION: Axillary padding without drainage was associated with a better post-operative course than suction drainage in this historical comparison, and the hospital stay was significantly shortened. There are only few series published on this new technique but they all indicate good feasibility and good tolerance. A large randomised multicentric evaluation is now warranted.

Satisfaction with care among low-income women with breast cancer

BACKGROUND

Patient satisfaction is an important outcome measure in determining quality of care. There are few data evaluating patient satisfaction in nonwhite, low-income populations. The objective of this study was to identify the structure, process, and outcome factors that impact patient satisfaction with care in a low-income population of women with breast cancer.

METHODS

In a cross-sectional survey of low-income women newly diagnosed with breast cancer, eligible women enrolled in the California Breast and Cervical Cancer Treatment Program (BCCTP) from February 2003 through September 2005 were interviewed by phone 6 months after their enrollment. This was a population-based sample of women aged >or=18 years (n = 924) with a definitive diagnosis of breast cancer and enrolled in the BCCTP. The main outcome measure was satisfaction with care received.

RESULTS

Random effects logistic regression revealed that less acculturated Latinas were more likely (odds ratio, [OR] = 5.36, p < 0.000) to be extremely satisfied with their care compared with non-Hispanic white women. Women who believed they could have been diagnosed sooner were less likely to be extremely satisfied (OR = 0.61, p < 0.000). Women who had received or were receiving radiotherapy or chemotherapy had nearly twice the odds of being extremely satisfied (OR = 2.02, p < 0.000, and OR = 2.13, p < 0.000, respectively). Greater information giving was associated with greater satisfaction (OR = 1.17, p < 0.000). Women reporting greater physician emotional support were more likely to report being extremely satisfied (OR = 1.26, p < 0.000). A higher participatory treatment decision-making score was associated with greater satisfaction (OR = 1.78, p < 0.000).

CONCLUSIONS

In a low-income population, satisfaction is also reported at high levels. In addition to age, ethnicity/acculturation, receipt of chemotherapy and radiotherapy, physician emotional support, and collaborative decision making, perception of diagnostic delay is a predictor of dissatisfaction in this population.

The effect of analgesic education on pain in patients undergoing breast surgery: within 24 hours after the operation

AIM

The goal of this study was to assess the effect of patient information about the analgesics used after breast surgery, on patient's level of pain and mobilisation ability.

BACKGROUND

Pain needs to be managed efficiently; in particular, for surgical cases, postoperative pain must be effectively controlled. Information about analgesic helped reduce the severity of pain.

DESIGN

This study was a clinical trial comparing a test group that received information about the analgesic to be used and a control group that received information as usual.

METHODS

Eighty-four patients who had a modified radical mastectomy or breast-conserving surgery were included in the study. Data were collected in a breast surgery clinic with a questionnaire, with the use of Short-form McGill-Melzack Pain Questionnaire and the Visual Analogue Scale. The test group received information about the surgical pain and the analgesics that would be used during the postoperative period.

RESULTS

The results showed that the level of pain reported by patients was similar in the test and control groups. However, the average level of postoperative pain in the test group was lower than that in the control group. The total pain reduction score for the test group, after surgery, was greater than for the control group. Following surgery, 73·8% of the test group and 50·0% of the control group achieved mobilisation within the first six hours.

CONCLUSION

Informing patients about the analgesics to be used for their care reduced pain and provided earlier mobilisation.

RELEVANCE TO CLINICAL PRACTICE

The findings of this study can provide guidance to nurses and improve analgesic control of pain management.

Limiting factors for development of ambulatory breast surgery in the French hospital network

INTRODUCTION

Ambulatory breast surgery is not well developed in France. This is especially true for oncologic procedures,

MATERIALS AND METHODS

Between January 2005 and June 2006, we performed a retrospective evaluation of the factors thought to limit the development of this type of hospitalization.

RESULTS

The principal limiting factors were distance restrictions (respect of the 100 km perimeter), the complexity of patient management for small breast tumors (several practitioners involved) and last, the non-motivating reimbursement policy.

CONCLUSION

By changing to the Anglo-American ("one day surgery", i.e. hospital stay less than 24 hours) or hybrid system (less than 12 hours+1 day surgery), ambulatory surgery could easily be offered to patients excluded by the current system (ambulatory department open less than 12 hours).

Same-day breast cancer surgery: a qualitative study of women's lived experiences

PURPOSE/OBJECTIVES

To understand the experiences of women having same-day breast cancer surgery and make recommendations to assist healthcare professionals effect change to enhance quality of care.

RESEARCH APPROACH

Thematic analysis of audiotaped interviews.

SETTING

Outpatient departments of two city hospitals on the east coast of Canada.

PARTICIPANTS

Purposive sample of 13 women who had undergone same-day breast cancer surgery.

METHODOLOGIC APPROACH

A constructivist approach with in-depth interviews and comparative analysis to develop and systemically organize data into four major interrelated themes and a connecting essential thread.

MAIN RESEARCH VARIABLES

Women's experiences with same-day breast cancer surgery.

FINDINGS

The themes of preparation, timing, supports, and community health nursing intervention were of paramount importance for effective coping and recovery. Women who had a positive experience with same-day breast cancer surgery also reported having adequate preparation, appropriate timing of preparation, strong support systems, and sufficient community health nursing intervention. Those reporting a negative experience encountered challenges in one or more of the identified theme areas.

CONCLUSIONS

Same-day surgery is a sign of the times, and the approach to it is changing. Healthcare systems need to be responsive to such changes. Although same-day surgery for breast cancer is not suitable for every patient, women undergoing this type of surgery should be assessed individually to determine whether it is appropriate for them.

INTERPRETATION

Women undergoing breast cancer surgery should be screened for same-day surgery suitability. Those having same-day breast cancer surgery should be prepared adequately with timely education. Most importantly, such women should receive community health nursing follow-up for assessment, continuing education, and psychosocial support.

Reasons for nursing telephone counseling from individuals discharged in the early postoperative period after breast surgery

The aim of this study was to determine the rate of and causes of asking for telephone counseling in patients undergoing modified radical mastectomy (MRM) and breast-conserving surgery (BCS), and discharged one night after surgery.

METHOD

This is a randomized descriptive study. This study was conducted on surgery service of a university hospital in Istanbul, Turkey, with MRM and BCS patients. This study sample included 174 patients. Inclusion criteria were staying in hospital for one night and being discharged, ability to talk on the phone, and being a candidate for MRM or BCS. Data were collected on a form that was developed by the researcher after consultation with experts, reviewing THE related literature, and clinical observations. The patients were given two mobile telephone (for two of the researchers) and home telephone number (for two of the researchers) that had an answering machine and were encouraged to call or leave a message for health problems they experienced at home.

RESULTS

A higher rate of the patients undergoing mastectomy asked for telephone counseling. The rate of the women asking for telephone counseling was very high within the first 6 weeks of discharge. The leading causes of asking for telephone counseling were wound problems, arm exercises, and difficulties in adapting to daily living activities. The women also had a psychological problem: fear of inability to recover.

CONCLUSIONS

The study found that home follow-up of patients undergoing mastectomy was particularly important.

Predictors of patient satisfaction in surgery

BACKGROUND

We sought to evaluate the satisfaction of surgical patients in order to identify predictors of patient satisfaction, using a cross-sectional surgery patients' survey in 24 public hospitals in Spain and a total of 15,539 inpatients and 7,899 outpatients.

RESULTS

Seventy-seven percent of inpatients and 88.3% of outpatients were satisfied (chi(2) = 509.31; P < .0001). Case-mix and hospital size were associated with satisfaction in inpatients (chi(2) = 19.31; P = .013). Older inpatients tended to be more satisfied (chi(2) = 80.54; P = .001), whereas; younger outpatients showed higher satisfaction levels (chi(2) = 51.73; P = .004). The most influential factors on inpatient satisfaction were information at admission (odds ratio [OR], 4.05; 95% confidence interval [CI], 2.91-5.63), knowing what type of professional one was dealing with at any given time (OR, 4.01; 95% CI, 3.01-5.34), and informed consent (OR, 3.37; 95% CI, 2.41-4.71). For outpatients, the most influential factors were informed consent (OR, 7.62; 95% CI, 3.68-15.80) and information about home care after discharge (OR, 7.010; 95% CI, 3.06-15.96).

CONCLUSION

We should consider the importance of patient information before and after treatment in the design of clinical pathways to offer better and more comprehensive care to surgical patients.

Breast cancer surgery in an ambulatory setting

AIM

To evaluate the feasibility and efficacy of outpatient surgery for early breast cancer in an Italian ambulatory setting and to assess its benefits.

PATIENTS AND METHODS

A review of 88 women treated for breast cancer from an outpatient facility was undertaken from July 2003 to December 2006. The patients were selected for ambulatory surgery according to specific social, environmental, physical and oncological criteria.

RESULTS

Eighty-eight women underwent a total of 107 surgical interventions in an ambulatory setting. Sixty out of the eighty-eight patients (68%) received a one-day conclusive surgical treatment, and the remaining 28 patients were promptly treated in two phases. Among this latter group, 18 patients (68%) were treated only in an outpatient facility, whereas the other 10 patients require reintervention with hospitalization. There were no intraoperative complications. In the postoperative period, 14 complications were observed: 6 wound infections, 3 hematomas, 1 axillary seroma and 4 readmissions. The patients' readmissions were due to nausea and emesis in one case, disphnoea in another case, and only two readmissions were due to surgical complications (hematoma in both cases). Patients that were interviewed exhibited a high level of satisfaction from the treatments they received.

DISCUSSION

This study confirms the feasibility, efficacy and safety of the outpatient setting regime, which is highly appreciated by women and is more cost effective than surgery in a hospital setting.

Incidence of Complications in Outpatient Mastectomy with Immediate Reconstruction

BACKGROUND

Although breast surgery, including mastectomy, is increasingly being performed on an outpatient basis, skepticism remains about the safety of outpatient mastectomy with immediate breast reconstruction. Studies have demonstrated a psychologic benefit to outpatient breast surgery in addition to the clear financial benefit. We sought to determine whether or not the postoperative complication rate after outpatient mastectomy with immediate reconstruction is low enough to consider the procedure safe and effective.

STUDY DESIGN

Charts were retrospectively reviewed for all patients who underwent outpatient mastectomies with immediate breast reconstruction at St Vincent's Comprehensive Cancer Center between December 2000 and June 2004. The presence or absence of postoperative complications was determined from records during the postoperative period and subsequent office visit.

RESULTS

Of 29 outpatient mastectomies with immediate reconstruction performed on 28 patients (one had independent procedures on each breast), only one procedure (3%) required subsequent admission to the hospital (for bleeding). Other complications included three seromas, two cases of cellulitis requiring antibiotics, and one hematoma. The overall complication rate was 24% (7 of 29), with only 14% (1 of 7) of the complications requiring hospitalization.

CONCLUSIONS

These results demonstrate that outpatient mastectomy with immediate reconstruction is a safe and effective procedure for carefully selected patients. The complication rates for our patient population are similar to those in other published reports on outpatient operations, most notably, those of outpatient mastectomy without immediate reconstruction.

Omission of fentanyl during sevoflurane anesthesia decreases the incidences of postoperative nausea and vomiting and accelerates postanesthesia recovery in major breast cancer surgery

PURPOSE

Our purpose was to investigate the effect of omission of fentanyl during sevoflurane anesthesia on the incidences of postoperative nausea and vomiting and on postanesthesia recovery in female patients undergoing major breast cancer surgery.

METHODS

Female patients (American Society of Anesthesiologists [ASA] physical status [PS] class I-II; age, 28-84 years) undergoing major breast cancer surgery were randomized to one of two anesthesia maintenance groups: sevoflurane-fentanyl anesthesia (SF; n = 25) or fentanyl-free sevoflurane anesthesia (S; n = 26). All patients were administered with propofol 2 mg x kg(-1) intravenously for anesthesia induction, a laryngeal mask airway was placed, and they received rectal diclofenac and local infiltration anesthesia. Anesthesia was maintained with sevoflurane in oxygen-air and they breathed spontaneously. The patients in group SF received fentanyl 0.1 mg intravenously and those in group S received normal saline during anesthesia.

RESULTS

Group SF revealed higher incidences of postoperative nausea (68% vs 27%) and vomiting (32% vs 8%) in the first 24 postoperative hours than group S. The median (25th-75th percentile) length of time from postanesthesia care unit (PACU) admission to ambulation was significantly longer in group SF (n = 23) at 195 min (158-219 min), than in group S, at 141 min (101-175 min). Two patients in group SF could not walk during the PACU stay.

CONCLUSION

Omission of fentanyl during sevoflurane anesthesia, combined with diclofenac and local infiltration anesthesia, decreases the incidences of postoperative nausea and vomiting and accelerates postanesthesia recovery in patients undergoing major breast cancer surgery.