Expanding Criteria for Same-Day Discharge after Mastectomy

Same-day discharge after mastectomy (SDM) is safe for patients meeting narrow eligibility criteria. Our institution embarked on a feasibility study for an SDM pathway with expanded eligibility criteria.

An SDM pathway was created to ensure proper education and expectations. Data were prospectively collected for all patients who underwent mastectomy from February 2022 to May 2023. Demographics, treatments, and complications were compared for patients who underwent SDM with those who stayed overnight. Patient-reported outcomes were collected via Recovery Tracker, an electronic platform that allows for daily postoperative patient inputs.

Of 1,664 patients, 1,580 patients (95%) stayed overnight; 84 patients (5%) elected for SDM, including 59 initially planned for SDM and 30 who converted from overnight stays to SDM. Five planned for SDM opted to stay overnight. Compared with overnight-stay patients, SDM patients were significantly older (61 vs 51 years, p < 0.001), more likely to undergo unilateral mastectomy (70% vs 46%, p < 0.001), and less likely to undergo reconstruction (32% vs 74%, p < 0.001). SDM patients lived significantly farther away from the hospital (34 vs 28 miles, p = 0.027). There was no significant difference in the number of complications experienced within 2 days after surgery; SDM patients experienced more complications within 30 days. There were no emergency room visits, transfers, or admissions. According to the Recovery Tracker, 3 SDM patients requested a nurse telephone call.

SDM is safe even with expanded criteria for patient eligibility. Selection or inclusion should not be limited by age, surgery, or distance from the hospital. Instead, patient motivation and clear expectation setting by clinical teams are relevant considerations.