Indiana University School of Medicine, Indianapolis, IN, USA.
Trihealth Cancer Institute, Cincinnati, OH, USA.
Ann Surg Oncol. 2022 Sep;29(9):5799-5808. doi: 10.1245/s10434-022-11799-4. Epub 2022 May 3.
Practices regarding recovery after mastectomy vary significantly, including overnight stay versus discharge same day. Expanded use of Enhanced Recovery After Surgery (ERAS) algorithms and the recent COVID pandemic have led to increased number of patients who undergo home recovery after mastectomy (HRAM).
The Patient Safety Quality Committee of the American Society of Breast Surgeons created a multispecialty working group to review the literature evaluating HRAM after mastectomy with and without implant-based reconstruction. A literature review was performed regarding this topic; the group then developed guidance for patient selection and tools for implementation.
Multiple, retrospective series have reported that patients discharged day of mastectomy have similar risk of complications compared with those kept overnight, including risk of hematoma (0-5.1%). Multimodal strategies that improve nausea and analgesia improve likelihood of HRAM. Patients who undergo surgery in ambulatory surgery centers and by high-volume breast surgeons are more likely to be discharged day of surgery. When evaluating unplanned return to care, the only significant factors are African American race and increased comorbidities.
Review of current literature demonstrates that HRAM is a safe option in appropriate patients. Choice of method of recovery should consider patient factors, such as comorbidities and social situation, and requires input from the multidisciplinary team. Preoperative education regarding pain management, drain care, and after-hour access to medical care are crucial components to a successful program. Additional investigation is needed as these programs become more prevalent to assess quality measures such as unplanned return to care, complications, and patient satisfaction.
乳房切除术的康复实践差异很大，包括住院过夜和当天出院。增强术后恢复（ERAS）算法的广泛应用以及最近的 COVID 大流行导致越来越多的患者在乳房切除术后进行家庭康复（HRAM）。
美国乳房外科医师学会的患者安全质量委员会成立了一个多专业工作组，审查了评估乳房切除术后有无植入物重建的 HRAM 的文献。对这一主题进行了文献回顾；然后，该小组为患者选择制定了指导意见，并为实施提供了工具。
多项回顾性研究报告称，与住院过夜的患者相比，当天出院的患者发生并发症的风险相似，包括血肿风险（0-5.1%）。改善恶心和镇痛的多模式策略可提高 HRAM 的可能性。在门诊手术中心和高容量乳房外科医生处接受手术的患者更有可能在手术当天出院。在评估计划外的医疗护理返回时，唯一的显著因素是非洲裔美国人种族和合并症增加。
对现有文献的回顾表明，HRAM 是合适患者的安全选择。康复方法的选择应考虑患者的因素，如合并症和社会状况，并需要多学科团队的投入。成功计划的关键组成部分是关于疼痛管理、引流护理以及下班后获得医疗护理的术前教育。随着这些计划的普及，需要进一步调查以评估质量指标，例如计划外的医疗护理返回、并发症和患者满意度。
