Physical, psychological, and economic advantages of accelerated discharge after surgical treatment for breast cancer.

The economic benefits of outpatient surgery and of short hospital stay have been amply emphasized over the past 5 years. The economic, physical, and psychological benefits of such an approach for treating patients with early breast cancer are detailed in this report. Of 208 patients treated by the author over a 3-year period (1991-1993), 63 (30.3%) were treated on an outpatient basis. Of 132 patients undergoing axillary node dissection, 29 (21.9%) were sent home the day of operation, and 95 (72%) stayed in the hospital overnight. The median number of lymph nodes removed was 17 and the median length of stay for all patients was one day; 31.8 per cent of these patients developed seromas, and 2 were readmitted for infected seromas. The per diem cost for our hospital in 1993 was $684. The program incorporates a strong institutional support component, with unlimited access to physicians and nurses, and has led to significant cost savings. It has also led to better physical and psychological recovery, emphasizing patient comfort, control and independence, and strong family interactions. Because 75 per cent of our 300 patients treated for breast cancer in our setting each year undergo axillary node dissection, $153,900 is expended for each day patients stay in our hospital, and presumably $92 million is expended country-wide. Adopting such a program can lead to significant savings without compromising the quality of care. The physical and psychological benefits of such an approach outweigh any minor inconveniences on patients and families.