Same-Day Discharge for Immediate Breast Reconstruction: A National Surgical Quality Improvement Program Study

Area of Science:

• Plastic Surgery
• Surgical Outcomes Research
• Health Economics

Background:

• Immediate breast reconstruction with tissue expanders often necessitates inpatient monitoring.
• Inpatient stays increase costs and risk of hospital-acquired infections.
• Same-day discharge offers potential benefits like resource conservation and faster patient recovery.

Purpose of the Study:

• To investigate the safety and efficacy of same-day discharge following mastectomy with immediate tissue expander placement.
• To compare perioperative complication rates between same-day, next-day, and later discharge groups.
• To identify patient-specific factors influencing complication risk.

Main Methods:

• Retrospective analysis of a large national database (National Surgical Quality Improvement Program) from 2005-2019.
• Inclusion of patients undergoing mastectomy with immediate tissue expander reconstruction.
• Statistical comparison of outcomes based on discharge timing (same-day, postoperative day 1, later).

Main Results:

• 10% of 14,387 patients were discharged same-day; 70% on postoperative day 1; 20% later.
• Infection, reoperation, and readmission rates increased with length of stay.
• Same-day and next-day discharge showed statistically equivalent complication rates; later discharge was associated with higher rates.

Conclusions:

• Same-day discharge is a safe and cost-effective alternative to overnight admission for select patients.
• Complication risk is comparable between same-day and next-day discharge.
• Individual patient health status, including comorbidities, should guide discharge decisions.