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Outpatient Mastectomy: Factors Influencing Patient Selection and Predictors of Return to Care

, Jennifer R. Dusendang, Sharon B. Chang, Margaret Ann Mentakis, Veronica C. Shim, Julie Schmittdiel, Gillian Kuehner
Published: 1 January 2021
Journal of the American College of Surgeons , Volume 232, pp 35-44; doi:10.1016/j.jamcollsurg.2020.09.015

Abstract: Critics of same-day discharge for mastectomy have denounced it as “drive-through” care.1Shahbazi S. Woods S.J. Influence of physician, patient, and health care system characteristics on the use of outpatient mastectomy.Am J Surg. 2016; 211: 802-809Abstract Full Text Full Text PDF PubMed Google Scholar Nonetheless, over time and with more robust support services, the physical and psychological benefits of early discharge after breast operation have been recognized.2Bonnema J. van Wersch A.M. van Geel A.N. et al.Medical and psychosocial effects of early discharge after surgery for breast cancer: randomised trial.BMJ. 1998; 316: 1267-1271Crossref PubMed Google Scholar Rising mastectomy rates across the US,3Mamtani A. Morrow M. Why Are there so many mastectomies in the United States?.Annu Rev Med. 2017; 68: 229-241Crossref PubMed Scopus (17) Google Scholar coupled with the recent COVID-19 pandemic, have driven healthcare systems to deliver efficient, effective, and safe care to breast cancer patients. Currently, one-third of bilateral mastectomies and one-half of unilateral mastectomies are performed in the outpatient setting.4Steiner C.A. Weiss A.J. Barrett M.L. et al.Trends in Bilateral and Unilateral Mastectomies in Hospital Inpatient and Ambulatory Settings, 2005–2013: Statistical Brief #201. AHRQ, Rockville, MD2016Google Scholar Same-day discharge for mastectomy patients mitigates potential harms and costs associated with an inpatient admission, conserves valuable hospital resources, and affords patients postoperative recovery in the comfort of their own homes without any increase in complication rates. Despite multiple retrospective series concluding that outpatient mastectomy is safe,5Cordeiro E. Jackson T. Cil T. Same-day major breast cancer surgery is safe: an analysis of short-term outcomes using NSQIP data.Ann Surg Oncol. 2016; 23: 2480-2486Crossref PubMed Google Scholar, 6Marla S. Stallard S. Systematic review of day surgery for breast cancer.Int J Surg. 2009; 7: 318-323Crossref PubMed Scopus (67) Google Scholar, 7Goodman A.A. Mendez A.L. Definitive surgery for breast cancer performed on an outpatient basis.Arch Surg. 1993; 128: 1149-1152Crossref PubMed Scopus (51) Google Scholar, 8Simpson S.A. Ying B.L. Ross L.A. et al.Incidence of complications in outpatient mastectomy with immediate reconstruction.J Am Coll Surg. 2007; 205: 463-467Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar adoption of this practice varies nationwide.4Steiner C.A. Weiss A.J. Barrett M.L. et al.Trends in Bilateral and Unilateral Mastectomies in Hospital Inpatient and Ambulatory Settings, 2005–2013: Statistical Brief #201. AHRQ, Rockville, MD2016Google Scholar,9Kruper L. Xu X.X. Henderson K. et al.Utilization of mastectomy and reconstruction in the outpatient setting.Ann Surg Oncol. 2013; 20: 828-835Crossref PubMed Scopus (22) Google Scholar,10Dumestre D.O. Redwood J. Webb C.E. Temple-Oberle C. Enhanced Recovery after Surgery (ERAS) protocol enables safe same-day discharge after alloplastic breast reconstruction.Plast Surg. 2017; 25: 249-254Crossref Scopus (11) Google Scholar
Keywords: ASA; American Society of Anesthesiologists physical status; ERAS; Enhanced Recovery after Surgery; LOS; length of stay; OM; outpatient mastectomy; RTC; return to care; SHR; Surgical Home Recovery; TRAS; Traditional Recovery after Surgery

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