From the Department of Surgery, University of Louisville School of Medicine, Louisville, KY (Caminiti, Jacobs, Spry, Scoggins, Wilhelmi, McMasters, Ajkay).
Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, KY (Maung, Gaskins).
J Am Coll Surg. 2024 Nov 1;239(5):455-462. doi: 10.1097/XCS.0000000000001164. Epub 2024 Oct 16.
Same-day mastectomy (SDM) protocols have been shown to be safe, and their use increased up to 4-fold compared with prepandemic rates. We sought to identify factors that predict overnight patient admission and evaluate the associated cost of care.
Patients undergoing mastectomy from March 2020 to April 2022 were analyzed. Patient demographics, tumor characteristics, operative details, perioperative factors, 30-day complication, fixed and variable cost, and contribution margin were compared between those who underwent SDM vs those who required overnight admission after mastectomy (OAM).
Of a total of 183 patients with planned SDM, 104 (57%) had SDM and 79 (43%) had OAM. Both groups had similar demographic, tumor, and operative characteristics. Patients who required OAM were more likely to be preoperative opioid users (p = 0.002), have higher American Society of Anesthesiology class (p = 0.028), and more likely to have procedure start time (PST) after 12:00 pm (49% vs 33%, p = 0.033). The rates of 30-day unplanned postoperative events were similar between SDM and OAM. Preoperative opioid user (odds ratio [OR] 3.62, 95% CI 1.56 to 8.40), postanesthesia care unit length of stay greater than 1 hour (OR 1.17, 95% CI 1.01 to 1.37), and PST after 12:00 pm (OR 2.56, 95% CI 1.19 to 5.51) were independent predictors of OAM on multivariate analysis. Both fixed ($5,545 vs $4,909, p = 0.03) and variable costs ($6,426 vs $4,909, p = 0.03) were higher for OAM compared with SDM. Contribution margin was not significantly different between the 2 groups (-$431 SDM vs -$734 OAM, p = 0.46).
Preoperative opioid use, American Society of Anesthesiology class, longer postanesthesia care unit length of stay, and PST after noon predict a higher likelihood of admission after planned SDM. OAM translated to higher cost but not to decreased profit for the hospital.
与大流行前相比，同一天完成乳房切除术（SDM）的方案已被证明是安全的，其使用增加了 4 倍。我们试图确定预测患者住院过夜的因素，并评估相关的护理成本。
分析了 2020 年 3 月至 2022 年 4 月期间接受乳房切除术的患者。比较了 SDM 组和乳房切除术后需要过夜住院（OAM）组患者的患者人口统计学、肿瘤特征、手术细节、围手术期因素、30 天并发症、固定和变动成本以及边际贡献。
在计划接受 SDM 的 183 名患者中，有 104 名（57%）接受了 SDM，79 名（43%）接受了 OAM。两组患者的人口统计学、肿瘤和手术特征相似。需要 OAM 的患者术前更有可能使用阿片类药物（p=0.002），美国麻醉医师协会（ASA）分级更高（p=0.028），手术开始时间更有可能在下午 12 点以后（49%比 33%，p=0.033）。SDM 和 OAM 组 30 天非计划性术后事件发生率相似。术前使用阿片类药物（比值比[OR]3.62，95%置信区间 1.56 至 8.40）、麻醉后护理病房停留时间超过 1 小时（OR 1.17，95%置信区间 1.01 至 1.37）和下午 12 点后（OR 2.56，95%置信区间 1.19 至 5.51）是多变量分析中 OAM 的独立预测因素。与 SDM 相比，OAM 的固定成本（$5545 比 $4909，p=0.03）和变动成本（$6426 比 $4909，p=0.03）均较高。两组间边际贡献无显著差异（SDM 为-$431，OAM 为-$734，p=0.46）。
术前使用阿片类药物、ASA 分级、麻醉后护理病房停留时间延长和下午后 PST 预测计划 SDM 后住院的可能性更高。OAM 导致成本增加，但对医院利润没有降低。
