Predictors of Same-Day Discharge After Mastectomy in the Elderly

There is ample evidence that same-day discharge (SDD) following mastectomy for breast cancer is safe and of higher value than hospital admission. Despite this evidence, elderly patients are often admitted following breast surgery.

The National Cancer Database was queried for patients with nonmetastatic breast cancer aged ≥18 y who underwent mastectomy. We compared rates of SDD and readmission within 30 d (R30D) between elderly (aged >65 y) and nonelderly over time and performed multivariable analysis for factors associated with SDD and R30D.

A total of 1,192,224 patients met criteria, with 34.7% aged ≥65 y ("elderly"). Rates of SDD and R30D after mastectomy were similar between elderly and nonelderly patients, and SDD rates increased over time while the probability of R30D decreased for both age groups. On multivariable analysis, the following factors were associated with a significantly lower likelihood of SDD in elderly patients: living in a rural area, having comorbidities, and undergoing a bilateral mastectomy, reconstruction, or axillary surgery. The following factors were associated with a higher likelihood of R30D: having comorbidities, undergoing reconstruction, and undergoing axillary surgery.

SDD after mastectomy is becoming more common, even in the elderly population. Additional support strategies for patients who have more comorbidities, are undergoing more extensive surgery, or who live in more remote locations should be developed to increase rates of successful SDD after mastectomy.