Implementation of a Post-mastectomy Home Recovery Program in a Large, Integrated Health Care Delivery System

Vuong, Brooke; Graff-Baker, Amanda; Yanagisawa, Mio; Chang, Sharon B.; Mentakis, Margaret; Shim, Vickie; Knox, Michele; Romero, Lucinda A.; Kuehner, Gillian

doi:10.1245/s10434-019-07551-0

Cited by 33 publications

(46 citation statements)

References 14 publications

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“…Keehn et al 16 showed that there was no difference in unexpected returns to the ED or readmissions to the hospital between SDS patients and those admitted for overnight. Vuong et al 23 showed no increase in the ED admittance or rate of reoperations or readmissions. Warren et al 6 showed nearly equal rates of complications and rehospitalization even in elderly women when comparing SDS and OS groups.…”

Section: Discussionmentioning

confidence: 95%

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

Tamminen

Meretoja

Koskivuo

2022

Journal of Surgical Oncology

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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.

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Section: Discussionmentioning

confidence: 95%

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

Tamminen

Meretoja

Koskivuo

2022

Journal of Surgical Oncology

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“…Prior implementation of an enhanced recovery protocol at our institution has decreased the need for opioid analgesia and length of hospital stay following mastectomy and implant-based breast reconstruction, thereby limiting the need for inpatient admission during the immediate postoperative period [12]. Similarly, Vuong et al reported successful implementation of a pilot postmastectomy home recovery program, demonstrating low rates of emergency department visits or re-admission for discharged patients [13]. In a recent study conducted by Keehn et al, the authors reported the release of nearly 831 hospital beds across 13 hospitals in Alberta, Canada, per year due to their same-day surgery pathway, with no difference in postoperative complication or hospital re-admission when compared to those admitted overnight per traditional mastectomy protocol [14].…”

Section: Electronic Supplementary Materialsmentioning

confidence: 95%

High-Efficiency Same-Day Approach to Breast Reconstruction During the COVID-19 Crisis

Specht

Sobti

Rosado

et al. 2020

Breast Cancer Res Treat

114

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Purpose As our hospitals conserve and re-allocate resources during the COVID-19 crisis, there is urgent need to determine how best to continue caring for breast cancer patients. During the time window before the COVID-19 critical peak and particularly thereafter, as hospitals are able to resume cancer operations, we anticipate that there will be great need to maximize efficiency to treat breast cancer. The goal of this study is to present a same-day protocol that minimizes resource utilization to enable hospitals to increase inpatient capacity, while providing care for breast cancer patients undergoing mastectomy and immediate breast reconstruction during the COVID-19 crisis. Methods IRB exempt patient quality improvement initiative was conducted to detail the operationalization of a novel same-day breast reconstruction protocol. Consecutive patients having undergone immediate breast reconstruction were prospectively enrolled between February and March of 2020 at Massachusetts General Hospital during the COVID-19 crisis. Peri-operative results and postoperative complications were summarized. Results Time interval from surgical closure to patient discharge was 5.02 ± 1.29 h. All patients were discharged home, with no re-admissions or emergency department visits. No postoperative complications were observed. Conclusion This report provides an instruction manual to operationalize a same-day breast reconstruction protocol, to meet demands of providing appropriate cancer treatment during times of unprecedented resource limitations. Pre-pectoral implantbased breast reconstruction can be the definitive procedure or be used as a bridge to autologous reconstruction. Importantly, we hope this work will be helpful to our patients and community as we emerge from the COVID-19 pandemic.

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“…We have previously published our organization’s experience with the implementation of the Surgical Home Recovery (SHR) initiative, which enabled the rapid transition from predominantly inpatient to predominantly outpatient mastectomies. 11 The SHR initiative was a coordinated and systematic approach, utilizing a variety of interventions starting with preoperative patient education including drain management, staff and surgeon support for same day discharge, applying Enhanced Recovery After Surgery (ERAS) principles of multimodal pain management, and close post-operative follow-up. Furthermore, we found that complication rates were low for all mastectomy patients and more importantly, the complication rates were the same whether a patient went home the same day as surgery or remained in the hospital overnight.…”

Section: Introductionmentioning

confidence: 99%

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

Vuong

Dusendang

Chang

et al. 2021

Journal of the American College of Surgeons

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BACKGROUND: After implementation of the Surgical Home Recovery (SHR) initiative for mastectomy within a large, integrated health delivery system, most patients are discharged on the day of the procedure. We sought to identify predictors of SHR and unplanned return to care (RTC). STUDY DESIGN: Mastectomy cases with and without reconstruction from October 2017 to August 2019 were analyzed. Patient characteristics, operative variables, and multimodal pain management were compared between admitted patients and SHR patients using logistic regression. We identified predictors of RTC in SHR patients, defined as 7-day readmission, reoperation, or emergency department visit. RESULTS: Of 2,648 mastectomies, 1,689 (64%) were outpatient procedures and the mean age of patients was 58.5 years. Predictors of SHR included perioperative IV acetaminophen (odds ratio [OR] 1.59; 95% CI, 1.28 to 1.97), perioperative opiates (OR 1.47; 95% CI, 1.06 to 2.02), and operation performed by a high-volume breast surgeon (OR 2.12; 95% CI, 1.42 to 3.18). Bilateral mastectomies (OR 0.70; 95% CI, 0.54 to 0.91), immediate reconstruction (OR 0.52; 95% CI, 0.39 to 0.70), and American Society of Anesthesiologists class 3 to 4 (OR 0.69; 95% CI, 0.54 to 0.87) decreased the odds of SHR. Of SHR patients, 111 of 1,689 patients (7%) experienced RTC. Patients with American Society of Anesthesiologists class 3 to 4 (OR 2.01; 95% CI, 1.29 to 3.14) and African American race (OR 2.30; 95% CI, 1.38 to 4.91) were more likely to RTC; receiving IV acetaminophen (OR 0.56; 95% CI, 0.35 to 0.88) and filling an opiate prescription (OR 0.51; 95% CI, 0.34 to 0.77) decreased the odds of RTC. CONCLUSIONS: Surgeon volume and multimodal pain medication increased the odds of SHR. Within the SHR group, American Society of Anesthesiologists Class 3 to 4 and African American patients increased the likelihood of RTC. This study helps optimize patient selection and perioperative practice for successful SHR.

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Implementation of a Post-mastectomy Home Recovery Program in a Large, Integrated Health Care Delivery System

Cited by 33 publications

References 14 publications

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

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

High-Efficiency Same-Day Approach to Breast Reconstruction During the COVID-19 Crisis

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

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