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Annals of Surgical Oncology

, Volume 26, Issue 10, pp 3178–3184 | Cite as

Implementation of a Post-mastectomy Home Recovery Program in a Large, Integrated Health Care Delivery System

  • Brooke VuongEmail author
  • Amanda N. Graff-Baker
  • Mio Yanagisawa
  • Sharon B. Chang
  • Margaret Mentakis
  • Veronica Shim
  • Michele Knox
  • Lucinda Romero
  • Gillian Kuehner
Breast Oncology

Abstract

Background

The number of outpatient mastectomies, with and without reconstruction, has increased nationwide. In well-selected patient populations, same-day surgery for mastectomy is a safe option. A pilot project was initiated within the Kaiser Permanente Northern California healthcare system to facilitate surgical home recovery (SHR) for mastectomy patients, including patients undergoing implant-based reconstruction and bilateral mastectomies.

Methods

Surgical home recovery for mastectomy patients was implemented in October 2017. Specific measures in this initiative included management of patient expectations at initial consultation, education about postoperative home care, multimodality pain management, and timely post-discharge follow-up. All patients undergoing mastectomy were included, except those undergoing autologous tissue reconstructions. After a 6-month implementation period, rate of same day discharge over 6 months was compared before and after the SHR initiative. We also compared emergency department (ED) visits, reoperations, and readmissions within 7 days.

Results

Twenty-one medical centers participated in this initiative. Before implementing SHR, 164 of the 717 (23%) mastectomies were outpatient procedures, compared with 403 of the 663 (61%) after the implementation period. Although the rate of outpatient mastectomy increased significantly, there were no statistically significant differences in ED visits (5.2% vs. 5.1%, p = 0.98), reoperation (3.5% vs. 3.5%, p = 0.99), or readmission rates (1.4% vs. 2.7%, p = 0.08).

Conclusions

By implementing standard expectations and sharing best practices, there was a significant increase in the rate of home recovery for mastectomy without compromising quality of patient care. The success of this pilot program supports SHR for mastectomy.

Notes

Disclosure

No disclosures.

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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Brooke Vuong
    • 1
    Email author
  • Amanda N. Graff-Baker
    • 2
  • Mio Yanagisawa
    • 3
  • Sharon B. Chang
    • 4
  • Margaret Mentakis
    • 1
  • Veronica Shim
    • 5
  • Michele Knox
    • 6
  • Lucinda Romero
    • 7
  • Gillian Kuehner
    • 8
  1. 1.Surgical Oncology, Department of SurgeryKaiser Permanente South Sacramento Medical CenterSacramentoUSA
  2. 2.Department of SurgeryThe Permanente Medical GroupSan JoseUSA
  3. 3.Department of SurgeryUniversity of California Davis Health SystemSacramentoUSA
  4. 4.Department of SurgeryThe Permanente Medical GroupFremontUSA
  5. 5.Department of SurgeryThe Permanente Medical GroupOaklandUSA
  6. 6.Department of OphthalmologyThe Permanente Medical GroupFremontUSA
  7. 7.Department of SurgeryThe Permanente Medical GroupSanta RosaUSA
  8. 8.Department of SurgeryThe Permanente Medical GroupVallejoUSA

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