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Kim LS, Moore MS, Schneider E, Canner J, Ayyala H, Chen J, Anant P, Graetz E, Lynch MA, Zanieski G, Gillego A, Valero MG, Proussaloglou EM, Berger ER, Golshan M, Greenup RA, Park TS. National Patterns of Hospital Admission Versus Home Recovery Following Mastectomy for Breast Cancer. Ann Surg Oncol 2024:10.1245/s10434-024-16107-w. [PMID: 39322830 DOI: 10.1245/s10434-024-16107-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 08/16/2024] [Indexed: 09/27/2024]
Abstract
BACKGROUND We examined national patterns of care and perioperative outcomes for women after mastectomy, comparing home recovery (HR) with hospital admission. PATIENTS AND METHODS Using Martketscan data (2017-2019), women ≥ 18 years old who underwent mastectomy ± reconstruction were identified and classified as either home recovery (same calendar day discharge) or hospital admission (stays > 1 calendar day). Comorbidities and receipt of chemo/immunotherapy 6 months prior to surgery and post-surgical 30-day complications were measured. Logistic regression calculated the odds of any complication by encounter type, adjusting for age, accompanying lymph node (LN) procedure, reconstruction, neoadjuvant chemo- and/or immunotherapy, and select comorbidities. RESULTS Of 11,789 mastectomy encounters (N = 11,659 women), 4751 (40%) cases utilized HR while 7038 (60%) had hospital admission. HR patients were older (53.6 years old vs. 51.8 years old) with lower rates of reconstruction (60.2 vs. 74.5%, p < 0.001). Rates of neoadjuvant chemotherapy (19.6 vs. 20.9%, p = 0.099) and immunotherapy (3.6 vs. 3.9%, p = 0.445) were similar between groups. Complication rates were lower among HR patients with fewer postoperative hematomas (0.6 vs. 1.3%, p < 0.001) and decreased wound complications (8.5 vs. 9.8%, p = 0.019). In a multivariable analysis, the odds of any complication were approximately 20% lower for HR patients compared with admission patients (aOR 0.81, 95% CI 0.72-0.91, p < 0.001). Unplanned emergency room visits were similar between groups (6.7 vs. 7.2%, p = 0.374); yet fewer hospital re-admissions (2.5 vs. 3.5%, p = 0.003) occurred in women recovering at home. CONCLUSION HR is a safe option compared with in-hospital admission for clinically appropriate women after mastectomy as they are less likely to experience postoperative complications, emergency department (ED) visits, or hospitalization.
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Affiliation(s)
- Leah S Kim
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Miranda S Moore
- Yale Center for Health Services and Outcome Research, New Haven, CT, USA
| | - Eric Schneider
- Yale Center for Health Services and Outcome Research, New Haven, CT, USA
| | - Joseph Canner
- Yale Center for Health Services and Outcome Research, New Haven, CT, USA
| | - Haripriya Ayyala
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Judy Chen
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Pavan Anant
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Elena Graetz
- Yale Center for Health Services and Outcome Research, New Haven, CT, USA
| | - Melanie A Lynch
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
- Yale Comprehensive Cancer Center, New Haven, CT, USA
| | - Gregory Zanieski
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
- Yale Comprehensive Cancer Center, New Haven, CT, USA
| | - Alyssa Gillego
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
- Yale Comprehensive Cancer Center, New Haven, CT, USA
| | - Monica G Valero
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
- Yale Comprehensive Cancer Center, New Haven, CT, USA
| | | | - Elizabeth R Berger
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
- Yale Comprehensive Cancer Center, New Haven, CT, USA
| | - Mehra Golshan
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
- Yale Comprehensive Cancer Center, New Haven, CT, USA
| | - Rachel A Greenup
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
- Yale Comprehensive Cancer Center, New Haven, CT, USA
| | - Tristen S Park
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
- Yale Comprehensive Cancer Center, New Haven, CT, USA.
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Manorot A, Uppal S, de Bear O, Stroup C, Dalton L, Rolston A, McCool K, Reynolds RK, McLean K, Siedel J, Straubhar AM. Avoidable admissions after minimally invasive hysterectomy. Int J Gynecol Cancer 2024; 34:1431-1436. [PMID: 39122446 DOI: 10.1136/ijgc-2024-005391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2024] Open
Abstract
OBJECTIVE To determine the rate of avoidable admissions following anticipated same-day discharge for patients undergoing minimally invasive hysterectomy and to identify risk factors associated with such admissions. METHODS A retrospective review was performed of patients who underwent a minimally invasive hysterectomy between March 2019 and July 2021 for a suspected gynecologic malignancy at a single tertiary care center. Pre-operatively, patients were assessed for same-day discharge versus planned admission. Reasons for day-of-surgery admission despite anticipated same-day discharge were categorized as anesthesia-related, system issues, intra-operative factors, post-operative pain, and social factors. Patients deemed not candidates for same-day discharge were defined as planned admissions. Indications were categorized as necessary or potentially avoidable. Descriptive and comparative statistics were used to summarize the cohort. RESULTS In total, 372 patients were identified: 261 (70.2%) anticipated same-day discharges and 111 (29.8%) planned admissions. Of anticipated same-day discharges, 230/261 (88.1%) were successfully discharged, while 31/261 (11.9%) required admission. Reasons for unplanned admissions were anesthesia-related (14/31, 45.2%), system issues (7/31, 22.6%), intra-operative factors (5/31, 16.1%), post-operative pain (3/31, 9.7%), and social factors (2/31, 6.5%). Among the 111 pre-operatively planned admissions, 81 (73.0%) were necessary due to comorbidities or surgical complexity, while 30 (27.0%) were potentially avoidable because patients could have been optimized for same-day discharge. Opportunities for optimization pre-operatively included comorbidities (13/30, 43.3%), system issues (8/30, 26.7%), social factors (6/30, 20.0%), and provider preference (3/30, 10.0%). CONCLUSION Most patients undergoing minimally invasive hysterectomy can be safely discharged the same day. Potentially avoidable admissions were primarily related to patient comorbidities that can be better optimized pre-operatively.
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Affiliation(s)
- Amanda Manorot
- Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - Shitanshu Uppal
- Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - Olivia de Bear
- Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - Cynthia Stroup
- Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - Liam Dalton
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Aimee Rolston
- Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - Kevin McCool
- Beaumont Health System, Royal Oak, Michigan, USA
| | - R Kevin Reynolds
- Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - Karen McLean
- Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Jean Siedel
- Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - Alli M Straubhar
- Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
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Tarr JT, Coomer CL, Kim SY, Ng M. Overnight to Outpatient: A Single Institution's Experience With Mastectomy and Reconstruction Before and After the Start of the COVID-19 Pandemic. Ann Plast Surg 2024; 93:43-47. [PMID: 38885164 DOI: 10.1097/sap.0000000000003922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
PURPOSE Minimizing resource use while optimizing patient outcomes has become an ever-growing component in modern healthcare, especially in the era of COVID-19. One essential component of this is deciding whether patients need hospital admission following elective procedures. The aim of this study is to investigate operative factors and patient outcomes when mastectomies with or without reconstruction are performed as ambulatory procedures versus planned inpatient admissions. METHODS Patient charts for those undergoing mastectomy with or without reconstruction were retrospectively analyzed ranging from March 2019 until February 2021. Factors such as demographic information, operative type, operating room time, cancer stage, total stay time in the medical environment, and postoperative complications were assessed and compared between the 2 groups. RESULTS A total of 89 patient charts were reviewed, 46 from before the COVID-19 pandemic and 43 from after the start of the pandemic. No differences were observed in demographic factors between the 2 groups. After surgical cases resumed a significant proportion, 79%, of mastectomies with or without reconstruction were performed in the ambulatory center, versus just 2% pre-COVID-19. Similarly, of all of these cases performed, only 19% resulted in hospital admission versus the previous rate of 100% (P < 0.00001). Together, these changes resulted in a significant reduction in length of stay of 39.77 ± 19.2 hours pre-COVID-19 versus 14.81 ± 18.4 hours afterward (P < 0.00001). Unfortunately, a higher number of patients who received surgery after the start of the pandemic elected to forego immediate reconstruction 49% versus 72% (P = 0.032). Most importantly, there were no observable differences found in 7-day readmission, reoperation, or emergency department visit between groups. There was also no difference in 30-day complication rate between groups. CONCLUSIONS Mastectomy with or without reconstruction can be safely performed in the ambulatory setting without additional risk of complications or negative patient factors. This divergence from traditional the protocol of inpatient overnight admission may contribute positively toward patient comfort, minimize the use of healthcare costs and resources, and allow for increased scheduling flexibility for patient and provider alike.
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Affiliation(s)
- Joseph T Tarr
- From the Northwell Health, Division of Plastic and Reconstructive Surgery, Great Neck, NY
| | - Cynara L Coomer
- Texas Health Harris Methodist Fort Worth City, Fort Worth, TX
| | - Sara Y Kim
- Scripps Clinical Medical Group, La Jolla, CA
| | - Marilyn Ng
- Northwell Health, Division of Plastic and Reconstructive Surgery, Staten Island, NY
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Zhou J, Xie Y, Liang F, Feng Y, Yang H, Qiu M, Zhang Q, Chung K, Dai H, Liu Y, Liang P, Du Z. A novel technique of reverse-sequence endoscopic nipple-sparing mastectomy with direct-to-implant breast reconstruction: medium-term oncological safety outcomes and feasibility of 24-hour discharge for breast cancer patients. Int J Surg 2024; 110:01279778-990000000-01048. [PMID: 38348883 PMCID: PMC11020081 DOI: 10.1097/js9.0000000000001134] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 01/24/2024] [Indexed: 04/18/2024]
Abstract
BACKGROUND Due to the short operation time and no need for special instruments, reverse-sequence endoscopic nipple-sparing mastectomy (R-E-NSM) with direct-to-implant breast reconstruction (DIBR) has been rapidly becoming popular in the last three years. However, there has yet to be an evaluation of its oncologic safety or the feasibility of discharging patients within 24 hours. MATERIALS AND METHODS In this single-center retrospective cohort study, individuals diagnosed with stage 0-III breast cancer between May 2020 and April 2022 who underwent traditional open mastectomy or R-E-NSM with DIBR were included. Follow-up started on the date of surgery and ended in December 2023. Data, including demographics, tumor characteristics, medium-term oncological outcomes, and postoperative complications, were collected and analyzed. Propensity score matching (PSM) was performed to minimize selection bias. RESULTS This study included 1679 patients (median [IQR] age, 50 [44-57] years). Of these, 344 patients underwent R-E-NSM with DIBR (RE-R group), and 1335 patients underwent traditional open mastectomy (TOM group). The median [IQR] follow-up time was 30 [24-36] months (29 [23-33] months in the RE-R group and 30 [24-36] months in the TOM group). Regarding before or after PSM, the P value of local recurrence-free survival (LRFS, 0.910 and 0.450), regional recurrence-free survival (RRFS, 0.780 and 0.620), distant metastasis-free survival (DMFS, 0.061 and 0.130), overall survival (OS, 0.260 and 0.620), disease-free survival (DFS, 0.120 and 0.330) were not significantly different between the RE-R group and the TOM group. The 3y-LRFS and 3y-DFS rates were 99.0% and 97.1% for the RE-R group and 99.5% and 95.3% for the TOM group, respectively. The rates of any complications and major complications were not significantly different between the RE-R patients who were discharged within 24 hours and the RE-R patients who were not discharged within 24 hours (P=0.290, P=0.665, respectively) or the TOM patients who were discharged within 24 hours (P =0.133, P=0.136, respectively). CONCLUSIONS R-E-NSM with DIBR is an innovative oncologic surgical procedure that not only improves cosmetic outcomes but also ensures reliable oncologic safety and fewer complications, enabling patients to be safely discharged within 24 hours. A long-term prospective multicenter assessment will be supporting.
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Affiliation(s)
- Jiao Zhou
- Department of General Surgery
- Breast Center
- Department of Thyroid and Breast Surgery, The First People’s Hospital of Ziyang, Sichuan University, Ziyang, China
| | - Yanyan Xie
- Department of General Surgery
- Breast Center
| | | | - Yu Feng
- Department of General Surgery, The Fourth People’s Hospital of Sichuan Province, Chengdu
| | | | | | - Qing Zhang
- Department of General Surgery
- Breast Center
| | | | - Hui Dai
- Department of General Surgery
- Breast Center
| | - Yang Liu
- Day Surgery Center, West China Hospital, Sichuan University
| | - Peng Liang
- Day Surgery Center, West China Hospital, Sichuan University
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Ardon AE, Nimma S, Nin OC. Twenty-three-hour stays in the ambulatory surgical center: benefits, pathways and protocols. Curr Opin Anaesthesiol 2023; 36:617-623. [PMID: 37615495 DOI: 10.1097/aco.0000000000001306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
PURPOSE OF REVIEW To summarize recent evidence that discusses the clinical, financial, and logistical implications of a 23 h stay postsurgical stay unit in an ambulatory surgical center (ASC). RECENT FINDINGS Twenty-three-hour stays in ambulatory surgery centers are safe, but proper patient selection and optimization are key to maintaining a high level of safety. The financial implications of overnight stays in ASCs rely heavily on payment structures and comparative costs at hospital-based outpatient surgery centers. The establishment of pathways and protocols for clinical care are key to the success of a 23 h stay at an ASC. SUMMARY A concurrent concern with the recent increase in outpatient surgery and medical complexity of cases performed in an ambulatory surgical center (ASC) is the possibility that patients may need overnight stay. Further, whether certain patients would benefit from anticipated 23 h observation rather than same-day discharge is an emerging topic. Overnight stays in ASCs may have financial advantages and decrease the risk of unanticipated admission with proper patient selection. The use of protocols and established pathways is key to the success of this model.
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Affiliation(s)
- Alberto E Ardon
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville
| | - Sindhuja Nimma
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville
| | - Olga C Nin
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
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6
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Ludwig KK. Choice of Hospital Setting for Modified Radical Mastectomy: Difference in Value? Ann Surg Oncol 2023; 30:4564-4565. [PMID: 37184570 DOI: 10.1245/s10434-023-13653-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/04/2023] [Indexed: 05/16/2023]
Affiliation(s)
- Kandice K Ludwig
- Department of Surgery, Indiana School of Medicine, Indianapolis, IN, USA.
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Bryan AF, Castillo-Angeles M, Minami C, Laws A, Dominici L, Broyles J, Friedlander DF, Ortega G, Jarman MP, Weiss A. Value of Ambulatory Modified Radical Mastectomy. Ann Surg Oncol 2023; 30:4637-4643. [PMID: 37166742 PMCID: PMC10173905 DOI: 10.1245/s10434-023-13588-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/13/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Modified radical mastectomy (MRM) still is largely performed in inpatient settings. This study sought to determine the value (expenditures and complications) of ambulatory MRM. METHODS Health Care Utilization Project (HCUP) state databases from 2016 were queried for patients who underwent MRM. The study examined rates of 30-day readmission for surgical-site infection (SSI) or hematoma, charges by index care setting, and predictors of 30-day readmission. RESULTS Overall, 8090 patients underwent MRM: 5113 (63 %) inpatient and 2977 (37 %) ambulatory patients. Compared with the patients who underwent inpatient MRM, those who underwent ambulatory MRM were older (61 vs. 59 years), more often white (66 % vs. 57 %), in the lowest income quartile (28 % vs. 21 %), insured by Medicare (43 % vs. 33 %) and residents in a small metro area (6 % vs. 4 %) (all p < 0.01). Of the 5113 patients treated as inpatients, 126 (2.5 %) were readmitted, whereas 50 (1.7 %) of the ambulatory patients were readmitted (p = 0.02). The adjusted charge for inpatient MRM without readmission was $113,878 (range, $107,355-120,402) compared with $94,463 (range, $86,021-102,907) for ambulatory MRM, and the charge for inpatient MRM requiring readmission was $159,355 (range, $147,142-171,568) compared with $139,940 (range, $125,808-154,073) for ambulatory MRM (all p < 0.01). This difference remained significant after adjustment for hospital length of stay. Adjusted logistic regression showed that the ambulatory setting was protective for readmission (odds ratio, 0.49; 95 % confidence interval, 0.35-0.70; p < 0.01). CONCLUSIONS The analyses suggest that ambulatory MRM is both safe and less expensive. The findings advocate that MRM, a last holdout of inpatient care within breast surgical oncology, can be transitioned to the ambulatory setting for appropriate patients.
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Affiliation(s)
- Ava Ferguson Bryan
- Department of Surgery, University of Chicago, Chicago, IL, USA
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Manuel Castillo-Angeles
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Christina Minami
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Alison Laws
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Laura Dominici
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Justin Broyles
- Harvard Medical School, Boston, MA, USA
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Gezzer Ortega
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Molly P Jarman
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Anna Weiss
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Division of Surgical Oncology, Department of Surgery, University of Rochester, Rochester, NY, USA.
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Brantley RA, Thuman J, Hudson T, Gregoski MJ, Scomacao I, Herrera FA. Same Day Discharge After Mastectomy and Immediate Implant-Based Breast Reconstruction: A Retrospective Cohort Comparison Using the National Surgical Quality Improvement Program Database. Ann Plast Surg 2023; 90:S395-S402. [PMID: 37332211 PMCID: PMC11177554 DOI: 10.1097/sap.0000000000003459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
INTRODUCTION Currently, overnight admission after immediate implant-based breast reconstruction (IBR) is the standard of care. Our study aims to analyze the safety, feasibility, and outcomes of immediate IBR with same-day discharge as compared with the standard overnight stay. METHODS The 2015-2020 National Surgical Quality Improvement Program database was reviewed to identify all patients undergoing mastectomy with immediate IBR for malignant breast disease. Patients were stratified into study (patients discharged day of surgery) and control (patients admitted after surgery) groups. Patient demographics, comorbidities, surgical characteristics, implant type, wound complications, readmission, and reoperation rates were collected and analyzed. Univariate and multivariate logistic regression was used to determine independent predictors of same-day discharge versus admission. In addition, Pearson χ2 test was used for comparison of proportions and t test was used for continuous variables unless distributions required subsequent nonparametric analyses. Statistical significance was defined as a P value less than 0.05. RESULTS A total of 21,923 cases were identified. The study group included 1361 patients discharged same day and the control group included 20,562 patient s admitted for average of 1.4 days (range, 1-86). Average age was 51 years for both groups. Average body mass index for the study group 27 and 28 kg/m2 for the control group, respectively. Total wound complication rates were similar (4.5% study, 4.3% control, P = 0.72). Reoperation rates were lower with same-day discharge (5.7% study, 6.8% control, P = 0.105), though not statistically significant. However, same-day discharge patients had a significantly lower readmission rate compared with the control (2.3% study, 4.2% control, P = 0.001). CONCLUSION National Surgical Quality Improvement Program data analysis over a 6-year period reveals that immediate IBR with same-day discharge is associated with a significantly lower readmission rate when compared with the standard overnight stay. The comparable complication profiles show that immediate IBR with same-day discharge is safe, potentially benefiting both patients and hospitals.
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Affiliation(s)
| | - Jenna Thuman
- Division of Plastic Surgery, Medical University of South Carolina
| | - Todd Hudson
- College of Medicine, Medical University of South Carolina
| | - Mathew J. Gregoski
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Isis Scomacao
- College of Medicine, Medical University of South Carolina
- Division of Plastic Surgery, Medical University of South Carolina
| | - Fernando A. Herrera
- College of Medicine, Medical University of South Carolina
- Division of Plastic Surgery, Medical University of South Carolina
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Ellsworth BL, Settecerri DJ, Mott NM, Vastardis A, Hider AM, Thompson J, Dossett LA, Hughes TM. Surgeon Perspectives on Determinants of Same-Day Mastectomy: A Roadmap for Implementing Change. Ann Surg Oncol 2023; 30:1712-1720. [PMID: 36536198 PMCID: PMC9762864 DOI: 10.1245/s10434-022-12934-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022]
Abstract
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.
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Affiliation(s)
| | - Daniel J Settecerri
- Center for Healthcare Outcomes and Policy, Michigan Medicine, Ann Arbor, MI, USA
| | - Nicole M Mott
- University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Andrew Vastardis
- Center for Healthcare Outcomes and Policy, Michigan Medicine, Ann Arbor, MI, USA
| | - Ahmad M Hider
- University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Jessica Thompson
- Department of Surgery, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Lesly A Dossett
- Department of Surgery, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
- Center for Healthcare Outcomes and Policy, Michigan Medicine, Ann Arbor, MI, USA
| | - Tasha M Hughes
- Department of Surgery, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
- Center for Healthcare Outcomes and Policy, Michigan Medicine, Ann Arbor, MI, USA.
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10
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Armstrong VL, Hammond JB, Jogerst KM, Kosiorek HE, Teven C, Cronin P, Ahmad S, Rebecca A, Casey W, Pockaj B. The Impact of Same-Day Discharge and Enhanced Recovery on Patient Quality of Life After Mastectomy with Implant Reconstruction. Ann Surg Oncol 2023; 30:2873-2880. [PMID: 36705818 PMCID: PMC9882739 DOI: 10.1245/s10434-022-13019-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/01/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND This study aimed to evaluate how enhanced recovery (ER) protocols and same-day discharge (SDD) influences patients' postoperative quality of life (QOL). METHODS Patients who underwent mastectomy with implant-based breast reconstruction from 2008 to 2020 were identified in a prospective database. The study assessed QOL with BREAST-Q and Was It Worth It? (WIWI) questionnaires. Responses were compared between the ER and pre-ER groups and between the SDD and hospital stay (HS) groups using one-way analysis of variance (ANOVA) and chi-square tests. RESULTS The inclusion criteria were met by 568 patients, with a 43% response rate, and 217 patients were included for analysis. Chest physical well-being was lower for the ER cohort, but postoperative breast satisfaction was higher. Psychosocial status, sexual well-being, and satisfaction with information given did not differ significantly between the ER group and the pre-ER or SDD group. In the compared groups, QOL did not differ significantly. CONCLUSIONS Enhanced recovery with SDD after mastectomy using implant-based reconstruction did not have an adverse impact on patient postoperative QOL.
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Affiliation(s)
- Valerie L. Armstrong
- Department of General Surgery. Division of Surgical Oncology, Mayo Clinic Arizona, Phoenix, USA
| | - Jacob B. Hammond
- Department of General Surgery. Division of Surgical Oncology, Mayo Clinic Arizona, Phoenix, USA
| | - Kristen M. Jogerst
- Department of General Surgery. Division of Surgical Oncology, Mayo Clinic Arizona, Phoenix, USA
| | - Heidi E. Kosiorek
- Department of Quantitative Health Sciences, Mayo Clinic Arizona, Phoenix, USA
| | - Chad Teven
- Department of Surgery. Division of Plastic Surgery, Mayo Clinic Arizona, Phoenix, USA
| | - Patricia Cronin
- Department of General Surgery. Division of Surgical Oncology, Mayo Clinic Arizona, Phoenix, USA
| | - Sarwat Ahmad
- Department of General Surgery. Division of Surgical Oncology, Mayo Clinic Arizona, Phoenix, USA
| | - Alanna Rebecca
- Department of Surgery. Division of Plastic Surgery, Mayo Clinic Arizona, Phoenix, USA
| | - William Casey
- Department of Surgery. Division of Plastic Surgery, Mayo Clinic Arizona, Phoenix, USA
| | - Barbara Pockaj
- Department of General Surgery. Division of Surgical Oncology, Mayo Clinic Arizona, Phoenix, USA
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11
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Kim LS, Park T, Berger ER, Golshan M, Greenup RA. Editorial Comment on: One-Year Experience of Same-Day Mastectomy and Breast Reconstruction Protocol. Ann Surg Oncol 2022; 29:5361-5363. [PMID: 35834143 PMCID: PMC9281278 DOI: 10.1245/s10434-022-12021-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 06/02/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Leah S Kim
- Department of Surgery, Yale Comprehensive Cancer Center, Yale University School of Medicine, New Haven, CT, USA
| | - Tristen Park
- Department of Surgery, Yale Comprehensive Cancer Center, Yale University School of Medicine, New Haven, CT, USA
| | - Elizabeth R Berger
- Department of Surgery, Yale Comprehensive Cancer Center, Yale University School of Medicine, New Haven, CT, USA
| | - Mehra Golshan
- Department of Surgery, Yale Comprehensive Cancer Center, Yale University School of Medicine, New Haven, CT, USA
| | - Rachel A Greenup
- Department of Surgery, Yale Comprehensive Cancer Center, Yale University School of Medicine, New Haven, CT, USA.
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12
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Ludwig KK, Rao R. ASO Author Reflections: Homing in on Safety-Home Recovery After Mastectomy. Ann Surg Oncol 2022; 29:5809-5810. [PMID: 35499787 PMCID: PMC9059435 DOI: 10.1245/s10434-022-11848-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 04/20/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Kandice K Ludwig
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Roshni Rao
- Department of Surgery, Columbia University Medical Center, New York, NY, USA
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