Schwartz Jean-Claude
Department of Surgery, Northside Gwinnett Surgical Associates, Northside Hospital Gwinnett, Lawrenceville, Ga.
Plast Reconstr Surg Glob Open. 2020 Jul 15;8(7):e2960. doi: 10.1097/GOX.0000000000002960. eCollection 2020 Jul.
Mastectomy and implant-based reconstruction is typically performed in a hospital setting (HS) with overnight admission. The aim of this study was to evaluate postoperative complications and outcomes with same-day discharge from an ambulatory surgery center (ASC) compared with the same surgery performed in the HS.
Patients who underwent mastectomy and immediate prepectoral tissue expander reconstruction were included in this retrospective study. Surgery was performed in an ASC with same-day discharge or the HS with overnight observation or same-day discharge. Patient demographics, operative details, outcomes, complications, and patient satisfaction were compared.
One hundred six women (183 breasts) underwent surgery in the HS, and 103 women (177 breasts) had their surgery in an ASC between August 2014 and September 2019. Demographics, comorbidities, and operative details were similar. Although there was no difference in the rates of most major complications, infectious complications requiring operative intervention were less frequent in the ASC [2.3% (n = 4) versus 11.5% (n = 21); = 0.001]. Patient satisfaction, evaluated with a 5-point Likert scale, was higher in the ASC.
Mastectomy and prepectoral reconstruction in an ASC is a safe alternative to the standard approach of performing this procedure in the HS. Although the rates of most surgical complications are similar between the HS and ASC, we have found a significantly reduced rate of major infectious complications requiring surgical intervention in the ASC which reduces overall cost and patient morbidity. Finally, patient satisfaction was higher in the ASC compared with the HS.
乳房切除术和基于植入物的重建手术通常在医院环境（HS）中进行，患者需住院过夜。本研究的目的是评估与在医院环境中进行相同手术相比，门诊手术中心（ASC）当日出院的术后并发症和结局。
本回顾性研究纳入了接受乳房切除术和即刻胸前组织扩张器重建的患者。手术在ASC中进行当日出院，或在HS中进行过夜观察或当日出院。比较患者的人口统计学特征、手术细节、结局、并发症和患者满意度。
2014年8月至2019年9月期间，106名女性（183侧乳房）在HS接受了手术，103名女性（177侧乳房）在ASC接受了手术。人口统计学特征、合并症和手术细节相似。尽管大多数主要并发症的发生率没有差异，但ASC中需要手术干预的感染性并发症较少见[2.3%（n = 4）对11.5%（n = 21）；P = 0.001]。用5点李克特量表评估的患者满意度在ASC中更高。
在ASC中进行乳房切除术和胸前重建是在HS中进行该手术的标准方法的安全替代方案。尽管HS和ASC之间大多数手术并发症的发生率相似，但我们发现ASC中需要手术干预的主要感染性并发症的发生率显著降低，这降低了总体成本和患者发病率。最后，与HS相比，ASC中的患者满意度更高。
