Same-Day Discharge After Mastectomy: Breast Cancer Surgery in the Era of ERAS.

BACKGROUND

Enhanced recovery after surgery (ERAS) principles have been beneficial in major abdominal surgery. ERAS was instituted in our breast surgery practice in 2017. The goal of this study was to evaluate the feasibility of outpatient mastectomies before and after ERAS.

METHODS

A retrospective review of all mastectomies between 1/2013 and 6/2018 was performed. Patients receiving autologous flap reconstruction were excluded. The institution-specific ERAS pathway began on February 1, 2017. Patient characteristics, operative intervention, and postoperative outcomes were compared between pre-ERAS and post-ERAS groups and between outpatient and inpatient subgroups. Continuous and categorical variables were compared using Wilcoxon rank-sum and Chi-square analyses.

RESULTS

A total of 487 patients were analyzed. Three hundred and forty-seven (71%) were prior to ERAS and 140 after (29%). The two groups were not significantly different in background characteristics. Same-day discharge occurred in 58.6% of post-ERAS patients versus 7.2% of pre-ERAS patients (p < 0.001). Liposomal bupivacaine block was used for pain control more in the post-ERAS group, 62.1% versus 6.1% (p < 0.001). Reconstruction type differed with 45.7% of the post-ERAS group undergoing direct-to-implant reconstruction versus 34.3% of pre-ERAS patients (p < 0.001) and with higher rates of submuscular implant and tissue expander placement in the pre-ERAS versus post-ERAS group (p < 0.001). Complications rates were lower in the post-ERAS group versus pre-ERAS group, 32.9% versus 52.4% (p < 0.001). The outpatient subgroup had higher rates of liposomal bupivacaine administration 74.4% versus 44.8% (p < 0.001). Baseline characteristics and complication rates did not differ between outpatient and admitted subgroups.

CONCLUSION

ERAS principles can be applied to breast cancer patients and allow for outpatient mastectomies with no increase in postoperative morbidity.