Ambulatory surgery for the patient with breast cancer: current perspectives

Abstract

Ambulatory breast cancer surgery is well accepted and is the standard ofcare at many tertiary centers. Rather than being hospitalized aftersurgery, patients are discharged on the day of surgery or within 23hours. Such early discharge does not adversely affect patient outcomesand has the added benefits of better psychological adjustment for thepatient, economic savings, and a more efficient utilization of healthcare resources. The minimal care needed post-discharge also means thatthe caregiver is not unduly burdened. Unplanned conversions to inpatientadmission and readmission rates are low. Wound complications areinfrequent and no issues with drain care have been reported. Because theperiod of postoperative observation is short and monitoring is not asintensive, ambulatory surgery is only suitable for low-risk proceduressuch as breast cancer surgery and in patients without seriouscomorbidities, where the likelihood of major perioperative events islow. Optimal management of pain, nausea, and vomiting is essential toensure a quick recovery and return to normal function. Regionalanesthesia such as the thoracic paravertebral block has been employed toimprove pain control during the surgery and in the immediatepostoperative period. The block provides excellent pain relief andreduces the need for opiates, which also consequently reduces theincidence of nausea and vomiting. The increasing popularity of totalintravenous anesthesia with propofol has also helped reduce theincidence of nausea and vomiting in the postoperative period. Ambulatorysurgery can be safely carried out in centers where there is awell-designed workflow to ensure proper patient selection, counseling,and education, and where patients and caregivers have easy access tomedical services should problems arise after discharge.