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Comparative Study
. 2020 Sep;27(9):3436-3445.
doi: 10.1245/s10434-020-08386-w. Epub 2020 Mar 27.

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

Kristen Jogerst  1 , Olivia Thomas  2 , Heidi E Kosiorek  3 , Richard Gray  4 , Patricia Cronin  4 , William Casey 3rd  5 , Alanna Rebecca  5 , Ryan Craner  6 , Tonia Young-Fadok  7 , Barbara Pockaj  4
Affiliations
Comparative Study

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

Kristen Jogerst et al. Ann Surg Oncol. 2020 Sep.

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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References

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