From the Division of Plastic Surgery, Department of Surgery, University of California at Los Angeles Health System, and David Geffen School of Medicine, University of California, Los Angeles.
Plast Reconstr Surg. 2024 Apr 1;153(4):683e-689e. doi: 10.1097/PRS.0000000000010822. Epub 2023 Jun 19.
Patients undergoing immediate breast reconstruction with tissue expanders are frequently admitted after surgery for monitoring and pain control, which introduces additional costs and risks of nosocomial infection. Same-day discharge could conserve resources, mitigate risk, and return patients home for faster recovery. The authors used large data sets to investigate the safety of same-day discharge after mastectomy with immediate postoperative expander placement.
A retrospective review was performed of patients in the National Surgical Quality Improvement Program database who underwent breast reconstruction using tissue expanders between 2005 and 2019. Patients were grouped based on date of discharge. Demographic information, medical comorbidities, and outcomes were recorded. Statistical analysis was performed to determine efficacy of same-day discharge and identify factors that predict safety.
Of the 14,387 included patients, 10% were discharged the same day, 70% on postoperative day 1, and 20% later than postoperative day 1. The most common complications were infection, reoperation, and readmission, which trended upward with length of stay (6.4% versus 9.3% versus 16.8%), but were statistically equivalent between same-day and next-day discharge. The complication rate for later-day discharge was statistically higher. Patients discharged later had significantly more comorbidities than same or next-day discharge counterparts. Predictors of complications included hypertension, smoking, diabetes, and obesity.
Patients undergoing mastectomy with immediate tissue expander reconstruction are usually admitted overnight. However, same-day discharge was demonstrated to have an equivalent risk of perioperative complications as next-day discharge. For the otherwise healthy patient, going home the day of surgery is a safe and cost-effective option, although the decision should be made based on the individual patient.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
接受组织扩张器即刻乳房重建的患者在手术后经常因监测和疼痛控制而入院，这会增加额外的成本并增加医院感染的风险。当日出院可以节约资源、降低风险并使患者更快地返回家中康复。作者使用大型数据集调查了在乳房切除术和即刻术后扩张器放置后当日出院的安全性。
对 2005 年至 2019 年期间在国家外科质量改进计划数据库中接受组织扩张器乳房重建的患者进行了回顾性研究。根据出院日期对患者进行分组。记录人口统计学信息、合并症和结局。进行统计学分析以确定当日出院的疗效，并确定预测安全性的因素。
在 14387 例纳入患者中，有 10%在当日出院，70%在术后第 1 天出院，20%在术后第 1 天以后出院。最常见的并发症是感染、再次手术和再入院，这些并发症随着住院时间的延长而呈上升趋势（6.4%比 9.3%比 16.8%），但在当日和次日出院之间统计学上无差异。较晚出院的并发症发生率统计学上更高。较晚出院的患者与当日或次日出院的患者相比，合并症明显更多。并发症的预测因素包括高血压、吸烟、糖尿病和肥胖。
接受即刻组织扩张器重建的乳房切除术患者通常需要住院过夜。然而，当日出院与次日出院相比，围手术期并发症的风险相当。对于身体状况良好的患者，当天手术回家是一种安全且具有成本效益的选择，但应根据患者个体情况做出决定。
临床问题/证据水平：治疗性，III 级。
