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Enhancing the clinical pathway for patients undergoing axillary lymph node dissection.
1Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA.
Breast (Edinburgh, Scotland)
|November 1, 2011
Summary
Axillary lymph node dissection (ALND) can be safely performed as a day-case procedure. This outpatient approach enhances hospital bed availability without compromising patient care quality.
Area of Science:
- Surgical Oncology
- Outpatient Procedures
- Clinical Pathways
Background:
- Day-case axillary lymph node dissection (ALND) is not standard practice.
- Assessing the feasibility of converting inpatient ALND to an outpatient procedure.
- Identifying barriers and strategies for implementing an enhanced clinical pathway for outpatient ALND.
Purpose of the Study:
- Evaluate the safety and efficacy of day-case ALND.
- Determine the impact on patient care quality and continuity.
- Identify and address barriers to implementing outpatient ALND.
Main Methods:
- Prospective database of 282 patients undergoing ALND over 12 months.
- Assessed outcomes: same-day discharge, complication rates, readmission rates.
- Analysis of barriers including patient expectations, pain management, and preoperative education.
Main Results:
- 85.1% (240/282) of ALNDs were performed as outpatient procedures.
- Low readmission rate (0.8%) and reoperation rate (0.7%).
- Outpatient ALND freed up 240 hospital beds during the study period.
Conclusions:
- Axillary lymph node dissection (ALND) can be safely performed as a day-case procedure.
- Successful implementation requires a multidisciplinary team and enhanced patient education.
- Mindset shifts in patients and healthcare providers are crucial for adoption.
