Successful same day discharge after immediate post-mastectomy alloplastic breast reconstruction: A single tertiary centre retrospective audit

• Published in: Journal of plastic, reconstructive & aesthetic surgery Vol. 73; no. 6; pp. 1068 - 1074
• Main Authors: Oxley, Paul J., McNeely, Carlyn, Janzen, Rhonda, Mian, Rizwan A., Lee, Adrian T., Murabit, Amera, Wang, Peiwei, McNeely, David
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-06-2020
• Subjects: Breast reconstruction; Day care surgery; Enhanced recovery after anaesthetic; Implants; Post mastectomy reconstruction; Tissue expanders; Post mastectomy reconstruction; Day care surgery; Tissue expanders; Breast reconstruction; Implants; Enhanced recovery after anaesthetic
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2020.01.018

Immediate Post-Mastectomy Alloplastic Breast Reconstruction (IPMABR) traditionally requires a post-operative overnight stay. Recent initiatives have identified same day discharge as a safe option.
A retrospective audit of all cases at a tertiary breast cancer centre was performed. Patients received surgery at a day care facility or regional hospital (RH). Unplanned admission was defined as any patient unable to be discharged or any patient returning to the emergency room within the first 24 h. Planned admission cases had a history of BMI >40, obstructive sleep apnoea or previous anaesthetic complications. Data were collected on planned same day discharge, unplanned admission and planned admission cases. Factors differentiating the groups were identified and variables predicting unplanned admission were determined.
A total of 785 patients received IPMABR over a 5-year period of which 743 had satisfactory data sets for review. Greater than 96% of patients receiving care at the day care facility were successfully discharged. The success rate for same day discharge at the RH was 65%. We determined that the greatest variables determining successful planned discharge were shorter surgical time (67 min; SD 6 min; p<.01), shorter PACU time (130 min; SD 21 min; p<.01) and surgical institution (p<.01). This difference between institutions was significant when all other variables (age, co-morbidities, unilateral/bilateral and BMI) were controlled, indicating a strong institutional bias. There was no difference between groups in complication rates (infection, dehiscence, seroma and haematoma).
Same day discharge following IPMABR is safe and greatly reduces resource use. It is imperative that members of the perioperative team understand the validity and benefits of the programme to ensure success and reduce unplanned admissions.