Sibia Udai S, Klune John R, Turcotte Justin J, Holton Luther H, Riker Adam I
Department of Surgery, Anne Arundel Medical Center at Luminis Health, Annapolis, MD.
Department of Oncology, Anne Arundel Medical Center at Luminis Health, Annapolis, MD.
Ochsner J. 2022 Summer;22(2):139-145. doi: 10.31486/toj.21.0103.
Enhanced Recovery after Surgery for mastectomy has resulted in increased use of outpatient same-day mastectomy (SDM). Whether SDM leads to increased readmissions or reoperations is not well documented. This study examines national data to compare outcomes of SDM to an overnight stay. We analyzed the American College of Surgeons National Surgical Quality Improvement Program Participant Use Data File from 2016 to 2018 for all mastectomy cases. Cases with a length of stay (LOS) >1 day were excluded. Cases were then categorized into 2 LOS cohorts: SDM vs 1-day LOS. A total of 22,642 cases (80.8% 1-day LOS vs 19.2% SDM) were identified for the final analysis. Patients in the 1-day LOS group were more likely to be older (57.9 vs 54.0 years, <0.01), be female (98.0% vs 79.8%, <0.01), and have greater comorbidity (38.1% vs 30.7% American Society of Anesthesiologists classification 3 or 4, <0.01) compared to the SDM group. Multivariate analysis demonstrated no difference in risk for 30-day wound complications between the SDM and 1-day LOS groups. The risks for 30-day medical complications (1.60 odds ratio [OR], 95% CI 1.06-2.42, =0.02), reoperations (1.46 OR, 95% CI 1.17-1.81, <0.01), and readmissions (1.60 OR, 95% CI 1.25-2.05, <0.01) were higher in the 1-day LOS group. Even after excluding patients undergoing reoperation on the day of surgery, the risk for reoperations (2.3% vs 3.3%, <0.01) remained higher in the 1-day LOS group. Characteristics associated with 1-day LOS were hypertension, steroid use, diabetes, dyspnea, dependent functional status, bilateral procedures, and breast reconstruction. We demonstrate that SDM is a safe procedure, with no increase in risk for 30-day postoperative complications. Appropriate patients should be offered SDM.
乳房切除术后的加速康复导致门诊当日乳房切除术（SDM）的使用增加。SDM是否会导致再入院率或再次手术率增加，目前尚无充分记录。本研究分析全国数据，以比较SDM与过夜住院的结果。我们分析了美国外科医师学会国家外科质量改进计划2016年至2018年所有乳房切除病例的参与者使用数据文件。住院时间（LOS）>1天的病例被排除。然后将病例分为两个LOS队列：SDM与1天LOS。最终分析共确定了22642例病例（1天LOS占80.8%，SDM占19.2%）。与SDM组相比，1天LOS组的患者年龄更大（57.9岁对54.0岁，<0.01）、女性比例更高（98.0%对79.8%，<0.01）、合并症更多（美国麻醉医师协会分类3或4级的比例为38.1%对30.7%，<0.01）。多变量分析显示，SDM组和1天LOS组30天伤口并发症风险无差异。1天LOS组30天医疗并发症风险（优势比[OR]1.60，95%CI 1.06 - 2.42，P = 0.02）、再次手术风险（OR 1.46，95%CI 1.17 - 1.81，<0.01）和再入院风险（OR 1.60，95%CI 1.25 - 2.05，<0.01）更高。即使排除手术当天接受再次手术的患者，1天LOS组的再次手术风险（2.3%对3.3%，<0.01）仍然更高。与1天LOS相关的特征包括高血压、使用类固醇、糖尿病、呼吸困难、依赖性功能状态、双侧手术和乳房重建。我们证明SDM是一种安全的手术，术后30天并发症风险没有增加。应向合适的患者提供SDM。
