Same Day Discharges Among Elderly Mastectomy Patients: A Single Institution Prospective Study

Area of Science:

• Geriatric Oncology
• Surgical Oncology
• Patient Discharge Protocols

Background:

• Same-day mastectomy is a safe and valuable procedure.
• Elderly patients (≥ 65 years) have lower same-day discharge rates compared to younger counterparts.
• A protocol was developed to enhance same-day discharge for older adults.

Purpose of the Study:

• To implement and evaluate a protocol aimed at increasing same-day discharge rates for patients aged 65 and older undergoing mastectomy.
• To assess the safety and efficacy of the new protocol in an elderly population.

Main Methods:

• Patients aged ≥ 65 years were screened using a 5-factor modified frailty index.
• Frailty status notifications were sent to surgeons; moderate-to-high frailty patients were offered prehabilitation.
• Demographic, clinicopathologic data, length of stay, and complications were collected via chart review.
• The primary endpoint was same-day discharge, compared to a historic rate of 18.8%.

Main Results:

• 306 elderly patients were screened; 57 mastectomies were performed (18.6%).
• Median age was 72 years, with frailty scores ranging from 0 to 4.
• Same-day discharge was achieved in 56.1% of cases, a significant increase from the historic 18.8% (P < 0.00001).
• Median length of stay was 0 days.

Conclusions:

• The implemented protocol, including frailty screening and email notifications, significantly boosted same-day mastectomy discharges in elderly patients.
• Future work should focus on increasing prehabilitation referrals and evaluating patient-reported outcomes.