Day Case Mastectomy: A teaching hospital experience of introducing a change in practice
Association of Breast Surgery ePoster Library. Harvey K. 05/15/17; 166330; P107
Kate Harvey
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Abstract
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INTRODUCTION: 20-28% of women with breast cancer in UK undergo simple mastectomy. The majority of the patients undergo mastectomy with an overnight hospital stay. Day-Case surgery has improved outcomes for patients while reducing associated costs. The British Association of Day Surgery (BADS) recommends a day-case target of 30% for mastectomies. The key barriers are concerns regarding postoperative bleeding and whether routine use of drains can be omitted. ARTISS® is a fibrin sealant that promotes skin flap adherence, potentially reducing postoperative haematomas and facilitating drain-free, Day-Case mastectomy.
AIM: To increase Day-Case rates to the level recommended by BADS.
METHODS: We proposed a gradual change in practice, introducing the ARTISS tissue glue to achieve drain-less day-case surgery between November 2015 and August 2016. All patients undergoing mastectomy (Mx) +/- axillary surgery and axillary node clearance (ALNC) +/- breast conserving surgery (BCS) were included. Where suitable, the drain was omitted. The day surgery rates, the impact on post-operative seromas and the complication rates were monitored and recorded prospectively.
RESULTS: 133 patients were eligible: 93 Mx +/- sentinel node (SLNB), 20 ALNC+/- BCS, 30 Mx+ALNC. The average patient BMI was 27kg/m2. The average breast weight was 780g. Day-Case rates increased from 5% in the first trimester to 38% in the final one. 19% of Mx/SLNB and 50% of Mx/ALNC required seroma aspiration. The complication rate was unchanged.
CONCLUSIONS: An effective increase in day-case rates was achieved for women undergoing mastectomy and axillary clearance. The process was cost-effective with no observed increase in morbidity.
AIM: To increase Day-Case rates to the level recommended by BADS.
METHODS: We proposed a gradual change in practice, introducing the ARTISS tissue glue to achieve drain-less day-case surgery between November 2015 and August 2016. All patients undergoing mastectomy (Mx) +/- axillary surgery and axillary node clearance (ALNC) +/- breast conserving surgery (BCS) were included. Where suitable, the drain was omitted. The day surgery rates, the impact on post-operative seromas and the complication rates were monitored and recorded prospectively.
RESULTS: 133 patients were eligible: 93 Mx +/- sentinel node (SLNB), 20 ALNC+/- BCS, 30 Mx+ALNC. The average patient BMI was 27kg/m2. The average breast weight was 780g. Day-Case rates increased from 5% in the first trimester to 38% in the final one. 19% of Mx/SLNB and 50% of Mx/ALNC required seroma aspiration. The complication rate was unchanged.
CONCLUSIONS: An effective increase in day-case rates was achieved for women undergoing mastectomy and axillary clearance. The process was cost-effective with no observed increase in morbidity.
INTRODUCTION: 20-28% of women with breast cancer in UK undergo simple mastectomy. The majority of the patients undergo mastectomy with an overnight hospital stay. Day-Case surgery has improved outcomes for patients while reducing associated costs. The British Association of Day Surgery (BADS) recommends a day-case target of 30% for mastectomies. The key barriers are concerns regarding postoperative bleeding and whether routine use of drains can be omitted. ARTISS® is a fibrin sealant that promotes skin flap adherence, potentially reducing postoperative haematomas and facilitating drain-free, Day-Case mastectomy.
AIM: To increase Day-Case rates to the level recommended by BADS.
METHODS: We proposed a gradual change in practice, introducing the ARTISS tissue glue to achieve drain-less day-case surgery between November 2015 and August 2016. All patients undergoing mastectomy (Mx) +/- axillary surgery and axillary node clearance (ALNC) +/- breast conserving surgery (BCS) were included. Where suitable, the drain was omitted. The day surgery rates, the impact on post-operative seromas and the complication rates were monitored and recorded prospectively.
RESULTS: 133 patients were eligible: 93 Mx +/- sentinel node (SLNB), 20 ALNC+/- BCS, 30 Mx+ALNC. The average patient BMI was 27kg/m2. The average breast weight was 780g. Day-Case rates increased from 5% in the first trimester to 38% in the final one. 19% of Mx/SLNB and 50% of Mx/ALNC required seroma aspiration. The complication rate was unchanged.
CONCLUSIONS: An effective increase in day-case rates was achieved for women undergoing mastectomy and axillary clearance. The process was cost-effective with no observed increase in morbidity.
AIM: To increase Day-Case rates to the level recommended by BADS.
METHODS: We proposed a gradual change in practice, introducing the ARTISS tissue glue to achieve drain-less day-case surgery between November 2015 and August 2016. All patients undergoing mastectomy (Mx) +/- axillary surgery and axillary node clearance (ALNC) +/- breast conserving surgery (BCS) were included. Where suitable, the drain was omitted. The day surgery rates, the impact on post-operative seromas and the complication rates were monitored and recorded prospectively.
RESULTS: 133 patients were eligible: 93 Mx +/- sentinel node (SLNB), 20 ALNC+/- BCS, 30 Mx+ALNC. The average patient BMI was 27kg/m2. The average breast weight was 780g. Day-Case rates increased from 5% in the first trimester to 38% in the final one. 19% of Mx/SLNB and 50% of Mx/ALNC required seroma aspiration. The complication rate was unchanged.
CONCLUSIONS: An effective increase in day-case rates was achieved for women undergoing mastectomy and axillary clearance. The process was cost-effective with no observed increase in morbidity.
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