Department of Surgery, Swedish Medical Center, Seattle, Washington, USA.
Department of Plastic Surgery, Swedish Medical Center, Seattle, Washington, USA.
World J Surg. 2024 Jan;48(1):104-109. doi: 10.1002/wjs.12006. Epub 2023 Dec 12.
Finite hospital resources has required a closer look at resource allocation. This has prompted a shift toward same day surgeries and a focus on reducing hospital readmissions. Following the institution of a same day discharge protocol for mastectomy and mastectomy with immediate reconstruction, we sought to assess differences in the length of stay and readmission rates.
This retrospective review evaluates all cases of mastectomy with or without immediate reconstruction performed at a single high-volume center between June 2019 and March 2021. Average length of stay, 30-day readmission rates, Anesthesia Society Assessment class, and type of immediate reconstruction were assessed. Autologous reconstructions were excluded.
A total of 413 patients underwent mastectomy with or without reconstruction (n = 148 pre protocol and n = 265 during protocol) between June 2019 and March 2021. Of those 413 patients, 180 underwent reconstruction (n = 62 pre protocol and n = 118 during protocol). The average length of stay after mastectomy following the implementation of the same day discharge protocol was decreased at 0.6 days (n = 265) compared to preimplementation at 1.02 days (n = 148), p < 0.001. The 30-day readmission rate was not significant between the groups, p = 0.13. A total of 180 patients underwent immediate reconstruction after mastectomy. The average length of stay after mastectomy with immediate reconstruction following implementation of the same day discharge protocol was shorter than preimplementation at 1.05 days preimplementation (n = 62) versus 0.58 days following implementation (n = 118), p < 0.001; this finding was significant for both prepectoral and subpectoral implants, p < 0.001. There was no significant difference in 30-day readmission rates between the groups with immediate reconstruction, p = 0.34.
Same day discharge for mastectomy with reconstruction is as safe as the more widely recognized same day discharge practice for patients with mastectomy alone.
有限的医院资源要求我们更密切地关注资源分配。这促使我们转向日间手术，并专注于减少医院的再入院率。在为乳房切除术和乳房切除术即刻重建实施当日出院方案后，我们试图评估住院时间和再入院率的差异。
本回顾性研究评估了 2019 年 6 月至 2021 年 3 月期间在一个单一的高容量中心进行的所有乳房切除术和即刻重建手术。评估平均住院时间、30 天再入院率、麻醉协会评估等级和即刻重建类型。排除了自体重建。
共有 413 名患者接受了乳房切除术和重建（n=148 例在方案前，n=265 例在方案后），时间为 2019 年 6 月至 2021 年 3 月。在这 413 名患者中，有 180 名患者接受了重建（n=62 例在方案前，n=118 例在方案后）。实施当日出院方案后，乳房切除术后的平均住院时间从 1.02 天（n=148）减少到 0.6 天（n=265），p<0.001。两组间 30 天再入院率无显著差异，p=0.13。共有 180 名患者在乳房切除术后立即接受重建。实施当日出院方案后，乳房切除术即刻重建后的平均住院时间短于方案前的 1.05 天（n=62），而实施后的 0.58 天（n=118），p<0.001；这一发现对于胸肌前和胸肌下植入物都是显著的，p<0.001。即刻重建组间 30 天再入院率无显著差异，p=0.34。
乳房切除术和重建的当日出院与更广泛认可的乳房切除术患者当日出院实践一样安全。
