Cost-effectiveness of a short stay admission programme for breast cancer surgery

Kok, M. de; Dirksen, Carmen D.; Kessels, Alfons G.H.; Velde, C.J. van de; Roukema, Jan A.; Bell, A.V.R.J.; Ent, F.W. van der; Meyenfeldt, M.F. von

doi:10.3109/02841861003610192

Cited by 18 publications

(16 citation statements)

References 17 publications

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“…Overrunning theatre lists as a cause of overnight admission have been reported also by others (17). Nevertheless, our finding is in line with other studies on DS management of breast cancer which reported same-day discharge rates ranging from 86% to 100% (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26). However, there is one small randomized study reporting lower rate of discharge on the same day of surgery (47%) mainly due to axillary clearance following frozen section evaluation of the sentinel nodes (27).…”

Section: Discussionsupporting

confidence: 91%

“…However, the reintervention rate in the current series was only 6.2%, supporting our belief that with careful pre-operative evaluation of the axillary lymph nodes by ultrasound and considering further criteria of risk for axillary node metastases (7,9), it is possible to select breast cancer patients with a reasonably low risk of lymph node metastases, that may safely benefit from this minimally invasive surgical approach. Indeed, previous studies on the same subject not using axillary ultrasound in the preoperative assessment, reported much higher reintervention rates, ranging from 28% to 40% (19,22). After the publication of the ACOSOG Z0011 (29) and IBCSG 23-01 trials (30) and the diffusion of the American Society of Clinical Oncology clinical practice guideline updated in 2016 (31), pointing out the futility of lymphadenectomy even in the presence of metastases in the sentinel lymph node, the traditional concept of ALND in breast cancer is currently questioned (32).…”

Section: Discussionmentioning

confidence: 95%

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Day Surgery Management of Early Breast Cancer: Feasibility and Psychological Outcomes

et al. 2019

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Background/Aim: Breast cancer treatment represents a substantial amount of health-care costs and has negative impact on womens' psychological health. Day-Surgery managment (DS) is a favorable alternative to a classic inpatient setting. In our prospective study we evaluated DS-treatment feasibility in terms of patient satisfaction, same-day-discharge rate, surgicalreintervention rate, psychological impact and costs. Patients and Methods: We operated on 131 early breast cancer patients in DS. Surgical outcomes were evaluated. In 64 DStreated breast cancer patients, psychological outcomes were analyzed using validated psychometric questionnaires and comparison was made with a corresponding group of women treated as inpatients. Results: The same-day-discharge rate was 95.4%. No patient required readmission. The surgicalreintervention rate was 6.2%. DS-treatment significantly reduced anxiety (p=0.05) and depression (p=0.01) and afforded cost savings of 49%. Conclusion: DS-treatment of early breast cancer was feasible, with low reintervention rate, reduced anxiety and depression, high patients' satisfaction and substantial financial savings.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 95%

Day Surgery Management of Early Breast Cancer: Feasibility and Psychological Outcomes

et al. 2019

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“…In our setting as well, cost reduction and the need to free limited bed space were the motivations for implementing this concept. Although much less than figures from developed countries, 24,25 the cost savings of~40 USD indirect cost of care in a country where the majority live below 1 USD per day is quite significant.…”

Section: Discussionmentioning

confidence: 84%

Safety and feasibility of early postmastectomy discharge and home drain care in a low resource setting

Olasehinde

Alatise

Arowolo

et al. 2018

Journal of Surgical Oncology

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Background Early postmastectomy discharge with a drain in place is standard practice in most developed countries. Its feasibility has not been evaluated in low resource settings like Nigeria. Methods Consenting patients undergoing mastectomy were discharged on the third postoperative day and assessed as outpatients for wound complications as well as their experience at home. Wound outcomes were compared with patients who had traditional long stay. Results Forty‐five of the 58 patients who had a mastectomy during the study period participated in the early discharge program (77.6%). Of these, four patients (8.9%) had drain malfunction, seroma occurred in eight patients (17.8%), eight patients (17.8%) had wound infection, and six patients (13.3%) had flap necrosis. There was no readmission. Compared with long stay patients, postoperative stay was significantly shorter (3 vs 11 days; P < 0.01) with significant cost savings, while complication rates were not statistically different. All the patients in the early discharge group were confident operating their drains and preferred early discharge. Being around relatives, reduced cost, and fear of the hospital environment were common reasons cited for their preference. Conclusion Our results support the implementation of an early postmastectomy discharge program in a low resource setting.

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“…Second, the policy cost-effectiveness will be calculated for the Short Stay Programme based on prospective data from breast cancer surgery patients. The cost-effectiveness analysis will use the same methodology as in the primary implementation study [19]. Third, the determinants of sustainability will be explored by means of in-depth semi-structured interviews with relevant stakeholders and external change agents.…”

Section: Methodsmentioning

confidence: 99%

“…In the current study two Dutch implementation cases are used for research on sustainability and its determinants (Additional file 1 and Additional file 2). A Short Stay Programme (MaDO) was implemented in breast cancer surgery in 4 early adopter hospitals by means of a hospital tailored implementation strategy [19-22], and the Enhanced Recovery After Surgery (ERAS) programme in colonic surgery was implemented in 33 hospitals by means of a generic implementation strategy [23,24]. As a result of these efforts (Table 1), both cases showed improved short-term results in terms of hospital length of stay.…”

Section: Introductionmentioning

confidence: 99%

Sustainability of healthcare innovations (SUSHI): long term effects of two implemented surgical care programmes (protocol)

Ament

Gillissen

Maessen

et al. 2012

BMC Health Serv Res

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BackgroundTwo healthcare innovations were successfully implemented using different implementation strategies. First, a Short Stay Programme for breast cancer surgery (MaDO) was implemented in four early adopter hospitals, using a hospital-tailored implementation strategy. Second, the Enhanced Recovery After Surgery (ERAS) programme for colonic surgery was implemented in 33 Dutch hospitals, using a generic breakthrough implementation strategy. Both strategies resulted in a shorter hospital length of stay without a decrease in quality of care. Currently, it is unclear to what extent these innovative programmes and their results have been sustained three to five years following implementation. The aim of the sustainability of healthcare innovations (SUSHI) study is to analyse sustainability and its determinants using two implementation cases.MethodsThis observational study uses a mixed methods approach. The study will be performed in 14 hospitals in the Netherlands, from November 2010. For both implementation cases, the programme aspects and the effects will be evaluated by means of a follow-up measurement in 160 patients who underwent breast cancer surgery and 300 patients who underwent colonic surgery. A policy cost-effectiveness analysis from a societal perspective will be performed prospectively for the Short Stay Programme for breast cancer surgery in 160 patients. To study determinants of sustainability key professionals in the multidisciplinary care processes and implementation change agents will be interviewed using semi-structured interviews.DiscussionThe concept of sustainability is not commonly studied in implementation science. The SUSHI study will provide insight in to what extent the short-term implementation benefits have been maintained and in the determinants of long-term continuation of programme activities.

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Cost-effectiveness of a short stay admission programme for breast cancer surgery

Abstract: A short stay programme as implemented is cost-effective compared with care as usual. In achieving good and more efficient quality of care, larger scale implementation is warranted.

Cited by 18 publications

References 17 publications

Day Surgery Management of Early Breast Cancer: Feasibility and Psychological Outcomes

Day Surgery Management of Early Breast Cancer: Feasibility and Psychological Outcomes

Safety and feasibility of early postmastectomy discharge and home drain care in a low resource setting

Sustainability of healthcare innovations (SUSHI): long term effects of two implemented surgical care programmes (protocol)

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