Patient, operative and pain management factors influencing inpatient compared with surgical day care mastectomy procedures at a community hospital

Abstract

Background: The COVID-19 pandemic highlighted the importance of maximizing same-day discharge after surgery to mitigate potential patient harms associated with inpatient admission and conserve valuable hospital resources. Adoption of same-day discharge after breast surgery, particularly mastectomy, has been slow despite recent research suggesting the physical and psychological benefits of same-day discharge after surgery. We sought to identify factors associated with inpatient compared with surgical day care mastectomy procedures at a community hospital in Vernon, British Columbia. Methods: We conducted a retrospective chart review of all patients who underwent a total mastectomy without reconstruction at Vernon Jubilee Hospital, a 196-bed community hospital, between April 2016 and March 2019. Patient characteristics, operative variables and pain management were compared between inpatient and surgical day care mastectomy procedures. We also compared 7-day readmission, reoperation and complications. Results: A total of 187 mastectomy patients were analyzed with 72 (38.5%) surgical day care procedures. Factors associated with inpatient procedures included longer operative time (66.1 min v. 53.5 min, p = 0.001), bilateral mastectomy (91% v. 9%, p = 0.01) and suspected or confirmed obstructive sleep apnea (32% v. 17%, p = 0.04). Preoperative acetaminophen (83% v. 17%, p < 0.001), multilevel intercostal block (83% v. 17%, p < 0.001) and a prescription for acetaminophen plus tramadol (58% v. 42%, p < 0.001) were associated with day care surgeries. There were no significant differences between the inpatient and surgical day care groups with respect to 7-day readmission, reoperation or postoperative complications. Conclusion: We found no significant differences in surgical outcomes between inpatients and those with same-day discharge after mastectomy procedures. These findings add to the growing body of evidence that surgical day care mastectomy procedures are safe in the community setting. Contexte: La pandémie de COVID-19 a mis en lumière l’importance d’encourager la chirurgie de 1 jour afin d’atténuer les risques associés à l’hospitalisation et de ménager les précieuses ressources hospitalières. L’adoption du congé le jour même après la chirurgie mammaire, et plus particulièrement la mastectomie, a été lente, même si de récentes recherches ont attesté de ses bienfaits physiques et psychologiques. Nous avons voulu comparer les facteurs propres à l’hospitalisation et à la chirurgie de 1 jour dans les cas de mastectomies dans un hôpital communautaire de Vernon en Colombie-Britannique.