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Same-Day Surgery for Mastectomy Patients in Alberta: A Perioperative Care Pathway and Quality Improvement Initiative

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

Abstract

Background

Same-day surgery (SDS) following mastectomy is safe and well accepted. Overnight admission in patients fit for discharge is an inefficient use of health resources. In response to a national review highlighting SDS following mastectomy at 1.4% in Alberta, a perioperative pathway was conceived.

Methods

The pathway was implemented across Alberta at 13 hospitals beginning in 2016. A steering committee was assembled, and clinical and administrative leads at each site were identified. Opportunities along the patient care experience whereby action could be taken to promote uptake of SDS were identified. Provincially branded support materials including presentations, order sets, and standard operating procedures were developed. Nurse educators provided in-service teaching such as standardized drain care and discharge teaching. Educational booklets, group classes, and online resources were developed for patients and families. An audit of SDS rates, unscheduled return to the emergency department (ED), and readmission rates was reported to teams quarterly, allowing for iterative modifications. Patient-reported experience measures (PREMs) were collected.

Results

SDS following mastectomy increased from 1.7 to 47.8%, releasing an estimated 831 bed days per year. No differences in unexpected return to the ED or readmission to hospital existed between SDS patients and those admitted overnight. A total of 102 patients completed the PREM survey, of whom 90% felt “excellent or good” with the plan to go home, how to care for themselves once home, and who to contact should issues arise.

Conclusions

Implementation of a provincial perioperative pathway improved uptake of SDS following mastectomy and demonstrated favorable PREMs.

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References

  1. Canadian Cancer Society’s Steering Committee on Cancer Statistics. Canadian cancer statistics 2017. Toronto: Canadian Cancer Society; (2017).

    Google Scholar 

  2. Alberta Health Services. Surveillance & reporting: 2012 report on cancer statistics in Alberta. Edmonton: Cancer Control Alberta, Alberta Health Services; (2015).

    Google Scholar 

  3. Alberta Health Services Tableau Dashboard. Mastectomy rate in Alberta. (2019). https://tableau.albertahealthservices.ca.

  4. Margolese RG, Lasry JC. Ambulatory surgery for breast cancer patients. Ann Surg Oncol. 2000;7(3):181–7.

    Article  CAS  PubMed  Google Scholar 

  5. Goodman AA, Mendez AL. Definitive surgery for breast cancer performed on an outpatient basis. Arch Surg. 1993;128(10):1149–52.

    Article  CAS  PubMed  Google Scholar 

  6. Seltzer MH. Partial mastectomy and limited axillary dissection performed as a same day surgical procedure in the treatment of breast cancer. Int Surg. 1995;80(1):79–81.

    CAS  PubMed  Google Scholar 

  7. Dravet F, Belloin J, Dupre PF, Fracois T, Robard S, Theard JL, Classe JM. Role of outpatient surgery in breast surgery. Prospective feasibility study. Ann Chir. 2000;125(7): 668–76.

    Article  CAS  PubMed  Google Scholar 

  8. Dooley WC. Ambulatory breast cancer surgery. Am J Surg. 2002;184(6):545–8.

    Article  PubMed  Google Scholar 

  9. Friedman D. Definitive breast cancer surgery as an outpatient: rationale and our experience. Ann Ital Chir. 2004;75(5):525–8.

    CAS  PubMed  Google Scholar 

  10. Wells M, Harrow A, Donnan P, et al. Patient, carer and health service outcomes of nurse-led early discharge after breast cancer surgery: a randomised controlled trial. Br J Cancer. 2004;91(4):651–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Athey N, Gilliam D, Sinha P, Kurup VJ, Hennessey C, Leaper DJ. Day-case breast cancer axillary surgery. Ann R Coll Surg Engl. 2005;87(2):96–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Carcano G, Uccella L, Ferrari A, et al. Breast cancer surgery as an outpatient in Italy: is it possible? Chir (Buchur). 2005;18:323–5.

    Google Scholar 

  13. Marchal F, Dravet F, Classe J, et al. Post-operative care and patient satisfaction after ambulatory surgery for breast cancer patients. Eur J Surg Oncol. 2005;31(5):495–9.

    Article  CAS  PubMed  Google Scholar 

  14. Marla S, Stallard S. Systematic review of day surgery for breast cancer. Int J Surg. 2009;7(4):318–23.

    Article  CAS  PubMed  Google Scholar 

  15. Weber W, Barry M, Junqueira M, Lee S, Mazella A, Sclafani L. Initial experiences with a multidisciplinary approach to decreasing the length of hospital stay for patients undergoing unilateral mastectomy. Eur J Surg Oncol. 2011;37(11):944–49.

    Article  CAS  PubMed  Google Scholar 

  16. Cordeiro E, Jackson T, Cil T. Same-day major breast cancer surgery is safe: an analysis of short-term outcomes using NSQIP data. Ann Surg Oncol. 2016;23(8):2480–6.

    Article  PubMed  Google Scholar 

  17. Duriaud H, Kroman N, Kehlet H. Feasibility and safety of outpatient breast cancer surgery. Dan Med J. 2018;65(3):A5458.

    PubMed  Google Scholar 

  18. Ny Y, Chan P, Chen J, Seah M, Teo C, Tan E. Adopting ambulatory breast cancer surgery as the standard of care in an Asian population. Int J Breast Cancer. 2014;672743.

  19. Robson N, Cutress R, Sainsbury R, Rew D, Royle G. Implementation of a short-stay programme after breast cancer surgery. Br J Surg. 2010;97:189–94.

    Article  Google Scholar 

  20. Ballardini B, Cavalli M, Manfredi G, et al. Surgical treatment of breast lesions at a day center: experience of the European Institute of Oncology. Breast. 2016;27:169–74.

    Article  PubMed  Google Scholar 

  21. Marrazzo A, Taormina P, David M, et al. Surgical treatment of early breast cancer in day surgery. Chir Ital. 2007;59(5):687–91.

    PubMed  Google Scholar 

  22. Bian J, Halpern, M. Trends in outpatient breast cancer surgery among Medicare fee-for-service patients in the United States from 1993–2002. Chin J Cancer. 2011;30(3):197–203.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Case C, Johantgen M, Steiner C. Outpatient mastectomy: clinical, payer and geographic influences. Health Serv Res. 2001;36(5):869–84.

    CAS  PubMed  PubMed Central  Google Scholar 

  24. de Kok M, Dirksen CD, Kessel AG, et al. Cost-effectiveness of a short stay admission programme for breast cancer surgery. Acta Oncol. 2010;49(3):338–46.

    Article  PubMed  Google Scholar 

  25. Canadian Partnership Against Cancer: Examining disparities in cancer control: a system performance special focus report. https://www.partnershipagainstcancer.ca/topics/disparities-in-cancer-control/ (2014). Accessed 9 April 2019.

  26. Porter G, Wagar B, Bryant H, et al. Rates of breast cancer surgery in Canada from 2007/08 to 2009/10: a retrospective cohort study. CMAJ Open. 2014;2(2):102–8.

    Article  Google Scholar 

  27. Straus SE, Tetroe J, Graham ID. Knowledge translation in health care: moving from evidence to practice (2nd ed). Oxford: BMJ Books; 2013.

    Book  Google Scholar 

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Acknowledgment

We would like to take the time to acknowledge the many contributions that supported this work including members of the CSCN, the Provincial Steering Committee Members, the clinical and administrative champions at the hospitals involved, and the two public advisors who sat on the Provincial Steering Committee.

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Correspondence to May Lynn Quan MD MSc FRCSC.

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The authors of this work have no commercial interests to disclose. This initiative was provincially funded by Alberta Health Services through the Cancer Strategic Clinical Network (SCN).

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Keehn, A.R., Olson, D.W., Dort, J.C. et al. Same-Day Surgery for Mastectomy Patients in Alberta: A Perioperative Care Pathway and Quality Improvement Initiative. Ann Surg Oncol 26, 3354–3360 (2019). https://doi.org/10.1245/s10434-019-07568-5

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  • DOI: https://doi.org/10.1245/s10434-019-07568-5

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