Comparing Discharge Timing in Patients Undergoing Immediate Implant-Based Breast Reconstruction: A Randomized...

Implementation of enhanced recovery after surgery (ERAS) programs have shown that same-day discharge of patients undergoing immediate implant-based reconstruction following mastectomy is safe. The purpose of this study was to compare outcomes of patients in ERAS programs undergoing mastectomy with immediate implant-based breast reconstruction discharged on the day of the surgery (postoperative day [POD] 0) versus POD 1.

A randomized controlled trial was conducted on patients who underwent immediate implant-based breast reconstruction after mastectomy. Patients were randomized to discharge on either POD 0 or POD 1. All patients completed perioperative patient-reported outcome (PRO) surveys and recorded postoperative opioid consumption (converted to morphine milligram equivalents). Thirty-day postoperative outcomes and complications were recorded.

A total of 217 breasts were reconstructed in 121 patients, with mean age of 48 years. The most frequent complication was seroma (4.8%), followed by mastectomy flap necrosis (2.4%). There were no significant differences in 30-day complications between the 2 cohorts. Ten patients presented to the emergency room within 30 days of discharge (POD 0 = 6 versus POD 1 = 4 patients patients) ( P = 0.52), with 4 patients requiring hospital admission. Six patients (5%) required reoperation (POD 0 = 4 patients versus POD 1 = 2 patients) ( P = 0.99). There was no difference in postoperative pain scores, postoperative milligram morphine equivalent consumption, or in PRO scores.

Regardless of whether mastectomy patients undergoing immediate implant-based breast reconstruction are discharged on POD 0 or POD 1, complication rates are similarly low with no difference in PROs or opioid consumption. ERAS pathways may be useful in optimizing patient care to allow for same-day discharge while maintaining high-quality care.