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Same-Day Discharge After Mastectomy: Breast Cancer Surgery in the Era of ERAS®

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Enhanced recovery after surgery (ERAS®) principles have been beneficial in major abdominal surgery. ERAS® was instituted in our breast surgery practice in 2017. The goal of this study was to evaluate the feasibility of outpatient mastectomies before and after ERAS®.

Methods

A retrospective review of all mastectomies between 1/2013 and 6/2018 was performed. Patients receiving autologous flap reconstruction were excluded. The institution-specific ERAS® pathway began on February 1, 2017. Patient characteristics, operative intervention, and postoperative outcomes were compared between pre-ERAS® and post-ERAS® groups and between outpatient and inpatient subgroups. Continuous and categorical variables were compared using Wilcoxon rank-sum and Chi-square analyses.

Results

A total of 487 patients were analyzed. Three hundred and forty-seven (71%) were prior to ERAS® and 140 after (29%). The two groups were not significantly different in background characteristics. Same-day discharge occurred in 58.6% of post-ERAS® patients versus 7.2% of pre-ERAS® patients (p < 0.001). Liposomal bupivacaine block was used for pain control more in the post-ERAS® group, 62.1% versus 6.1% (p < 0.001). Reconstruction type differed with 45.7% of the post-ERAS® group undergoing direct-to-implant reconstruction versus 34.3% of pre-ERAS® patients (p < 0.001) and with higher rates of submuscular implant and tissue expander placement in the pre-ERAS® versus post-ERAS® group (p < 0.001). Complications rates were lower in the post-ERAS® group versus pre-ERAS® group, 32.9% versus 52.4% (p < 0.001). The outpatient subgroup had higher rates of liposomal bupivacaine administration 74.4% versus 44.8% (p < 0.001). Baseline characteristics and complication rates did not differ between outpatient and admitted subgroups.

Conclusion

ERAS® principles can be applied to breast cancer patients and allow for outpatient mastectomies with no increase in postoperative morbidity.

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Acknowledgment

We would like to thank Mayo Clinic for supporting this research.

Funding

This research did not receive any specific grants from funding agencies in the public, commercial, or not-for-profit sectors.

Disclosure

The authors have no disclosures or commercial interests related to the subject of this study.

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Authors and Affiliations

  1. Department of Surgery, Division of Surgical Oncology and Endocrine Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA

    Kristen Jogerst MD, MPH, Richard Gray MD, Patricia Cronin MD & Barbara Pockaj MD

  2. Mayo Clinic School of Medicine, Phoenix, AZ, USA

    Olivia Thomas

  3. Department of Research-Biostatistics, Mayo Clinic Arizona, Phoenix, AZ, USA

    Heidi E. Kosiorek MS

  4. Department of Surgery, Division of Plastic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA

    William Casey III MD & Alanna Rebecca MD

  5. Department of Anesthesiology, Mayo Clinic Arizona, Phoenix, AZ, USA

    Ryan Craner MD

  6. Department of Surgery, Division of Colorectal Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA

    Tonia Young-Fadok MD

Authors
  1. Kristen Jogerst MD, MPH
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  2. Olivia Thomas
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  3. Heidi E. Kosiorek MS
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  4. Richard Gray MD
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  5. Patricia Cronin MD
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  6. William Casey III MD
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  7. Alanna Rebecca MD
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  8. Ryan Craner MD
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  10. Barbara Pockaj MD
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Corresponding author

Correspondence to Kristen Jogerst MD, MPH.

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Jogerst, K., Thomas, O., Kosiorek, H.E. et al. Same-Day Discharge After Mastectomy: Breast Cancer Surgery in the Era of ERAS®. Ann Surg Oncol 27, 3436–3445 (2020). https://doi.org/10.1245/s10434-020-08386-w

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  • DOI: https://doi.org/10.1245/s10434-020-08386-w

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