Factors Predicting Overnight Admission after Same-Day Mastectomy Protocol and Associated Financial Implications

Area of Science:

• Oncology
• Surgical Oncology
• Health Economics

Background:

• Same-day mastectomy (SDM) protocols are increasingly adopted, showing a 4-fold rise in use compared to pre-pandemic levels.
• Despite demonstrated safety, factors influencing overnight admission after mastectomy (OAM) and associated care costs require identification.

Purpose of the Study:

• To identify predictors of overnight admission following planned same-day mastectomy.
• To evaluate the economic impact of overnight admissions versus same-day discharges.

Main Methods:

• A retrospective analysis of 183 patients undergoing mastectomy between March 2020 and April 2022.
• Comparison of demographic, tumor, operative, and perioperative factors, 30-day complications, costs, and contribution margins between SDM and OAM groups.

Main Results:

• 43% of patients planned for SDM required OAM.
• Preoperative opioid use, higher American Society of Anesthesiology class, and later procedure start times predicted OAM.
• OAM was associated with significantly higher fixed and variable costs, but contribution margins were similar between groups.

Conclusions:

• Preoperative opioid use, ASA class, prolonged PACU stay, and afternoon procedure start times are independent predictors of OAM after planned SDM.
• Overnight admission increases healthcare costs but does not negatively impact hospital profitability.