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

Area of Science:

• Oncology
• Surgical Oncology
• Healthcare Management

Background:

• Nationwide increase in outpatient mastectomies, with and without reconstruction.
• Same-day surgery for mastectomy is safe in well-selected patients.
• Pilot project for surgical home recovery (SHR) in Kaiser Permanente Northern California.

Purpose of the Study:

• To evaluate the implementation of a surgical home recovery (SHR) program for mastectomy patients.
• To assess the impact of SHR on same-day discharge rates.
• To compare outcomes including emergency department visits, reoperations, and readmissions before and after SHR implementation.

Main Methods:

• Surgical home recovery (SHR) implemented in October 2017 for mastectomy patients (excluding autologous reconstructions).
• Key components: expectation management, postoperative home care education, multimodal pain management, and timely follow-up.
• Compared same-day discharge rates, ED visits, reoperations, and readmissions within 7 days pre- and post-SHR implementation over a 6-month period.

Main Results:

• Outpatient mastectomy rates increased significantly from 23% (164/717) before SHR to 61% (403/663) after implementation.
• No statistically significant differences were observed in emergency department visits (5.2% vs. 5.1%), reoperations (3.5% vs. 3.5%), or readmissions (1.4% vs. 2.7%).

Conclusions:

• Implementing standardized expectations and best practices for surgical home recovery (SHR) significantly increased home recovery rates for mastectomy patients.
• The SHR program demonstrated success without compromising patient care quality.
• The pilot program supports the broader adoption of SHR for mastectomy patients.