Early discharge after mastectomy. A safe way of diminishing hospital costs.

In order to assess the risks and benefits of early discharge after major breast surgery, the authors analyzed 73 consecutive private patients who underwent operations by four surgeons over a 1-year period. Patient's ages ranged from 34 to 84 years, with a mean of 56.2 years. One patient was excluded from analysis because thoracotomy with a pulmonary resection was performed during the same hospitalization. Thirty-seven patients underwent total mastectomy with complete axillary dissection, 30 underwent segmental mastectomy with complete axillary dissection, and five underwent total mastectomy alone. For each patient the chest wall and axilla were drained by means of one or two Jackson-Pratt (American Heyer Schulte Corp., Goleta, CA) closed suction drains. Prior to discharge, all patients were instructed in the proper technique of drain care and were directed to record the daily drainage. Patients were discharged when they were fully mobile, did not require injectable narcotics, and felt capable of taking care of the drains as outpatients. The length of postoperative stay ranged from 1 to 9 days (mean 2.9), with all but three patients being discharged by the fifth postoperative day. Patient acceptance of early discharge with drains was excellent. Drains were pulled on an outpatient basis, usually within 7 to 10 days after surgery. Complications were observed in twelve patients (18%), consisting of seromas (8 patients), cellulitis (2 patients), and minimal superficial skin necrosis (2 patients). All complications were managed easily on an outpatient basis. We conclude that early discharge with Jackson-Pratt drains remaining in place is safe, well tolerated by patients, and has tremendous potential for substantial cost savings.