Timing of mastectomy and the effect on the likelihood of outpatient surgery and cost savings in breast cancer patients.

Authors

Anna Levine, Corewell Health West
Mariam Khan, Corewell Health West Resident
Jesse K. Kelley, Corewell Health West Resident
Susanna Wang
Deepthi Devireddy
Erica Wrubel, Corewell Health West
Jessica L. Thompson, Corewell Health West
Amie M. Hop, Corewell Health West
Mathew H Chung, Corewell Health West
G Paul Wright, Corewell Health West Resident

Document Type

Article

Publication Date

3-2024

Publication Title

Surgery

Abstract

BACKGROUND: Same-day discharge after mastectomy has potential patient- and hospital-level benefits; however, few data are available regarding factors affecting the likelihood of same-day discharge in order to address barriers. We sought to evaluate factors contributing to same-day discharge, focusing on the timing of mastectomy during the operative day.

METHODS: We conducted a single-institution retrospective review of patients who underwent mastectomies for malignancy over a 3-y time frame. Clinicopathologic variables were collected along with a binary variable for mastectomy start time (morning versus afternoon). Our primary endpoint was rate of same-day discharge. A multivariable logistic regression model was constructed from significant univariate variables to determine independent predictors of same-day discharge. A secondary endpoint was a cost-utility analysis for morning versus afternoon start time, using hospital cost data.

RESULTS: There were 451 patients included in the analysis. Factors associated with same-day discharge rate included the American Society of Anesthesiologists score, use of a preoperative regional anesthesia block, type of mastectomy performed, individual surgeon variation, and a morning start for the mastectomy. On multivariable analysis, morning start was a strong independent predictor of same-day discharge (odd ratio = 2.83; 95% CI, 1.75-4.60). The cost-utility analysis favored a morning start, with average cost savings of $550 per patient.

CONCLUSION: Despite patient- and surgeon-specific variations, simple scheduling policies can improve same-day discharge rates after mastectomy, leading to improved hospital bed use and cost reduction.

Volume

175

Issue

3

First Page

671

Last Page

676

Recommended Citation

Levine A, Khan M, Kelley JK, Wang S, Devireddy D, Wrubel E, et al Thompson JL, Hop AM, Chung MH, Wright GP] Timing of mastectomy and the effect on the likelihood of outpatient surgery and cost savings in breast cancer patients. Surgery. 2024 Mar;175(3):671-676. doi: 10.1016/j.surg.2023.09.014. PMID: 37891061.

DOI

10.1016/j.surg.2023.09.014

ISSN

1532-7361

PubMed ID

37891061