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

Abstract

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.

Incidência e fatores associados a complicações em feridas operatórias de mulheres mastectomizadas

“…Na literatura, observa-se que as principais complicações apresentadas pós-mastectomia são infecção 4,9,26 , hematoma 4,27 , seroma 4,5,9,[27][28][29] , deiscência 4,9,27 , necrose 4,27 , sangramento 9 e celulite 27 . O que corrobora com o estudo, o qual também inclui a epidermólise como complicação incidente no pós-operatório de mastectomia.…”

“…As cirurgias de mama podem resultar em complicações de ferida operatória, como: infecção [4][5][6][7][8][9] , necrose 4,6,10 seroma 4,6,7,9,10 , deiscência 4,9 , sangramento 8,9 , hematoma 4,6,7,10 e epidermólise 11 . Tais complicações repercutem diretamente na vida desta mulher, pois pode gerar reinternações, aumentar os gastos hospitalares, mobilizar toda equipe de saúde, provocar problemas psicossociais e incapacitantes, podendo inclusive levar o paciente a óbito 12 ou ao atraso do início da terapia adjuvante 13 .…”

Does rapid discharge after breast cancer surgery have an impact on wound healing and complications? COVID‐19 pandemic experience

“…Other studies investigating complication rates of early discharge with drains in the pre-pandemic era had comparable results. 11,12 Staying away from the hospital flora, better physical and psychosocial performance during home follow-up compared with the hospital environment may be possible justifications for the results. In addition, there was a significant decrease in the health care expenses in the early discharge group, because of lower hospitalisation and having less complications compared with long-stay group.…”

Commentary: Do you live in a distressed community? How do you know? What does this mean? What are the risks? How do you get help?

“…Most, but not all, common medical and surgical disorders have worse outcomes in patients from distressed communities ( Table 1). [8][9][10][11][12][13][14][15][16][17][18][19][20][21] DOES LIVING IN A DISTRESSED COMMUNITY CAUSE WORSE OUTCOMES FROM SURGICAL PROCEDURES? Table 1 suggests that living in a distressed community is associated with worse outcomes from many medical disorders and from surgical interventions.…”