Outpatient Mastectomy with Reconstruction at Ambulatory Surgery Centers

BACKGROUND: While ambulatory surgery centers (ASCs) are increasingly utilized for outpatient surgery for cost savings and resource efficiency, data comparing outcomes and costs of same-day mastectomy (SDM) with reconstruction at ASCs versus hospital outpatient departments (HOPDs) remain limited. We aimed to identify predictors of overnight admission following SDM with immediate implant/tissue expander reconstruction, and evaluate its safety, feasibility, and cost-efficacy at ASCs versus HOPDs.

We performed a retrospective review of women undergoing mastectomy with immediate implant/tissue expander reconstruction from January 2023 to June 2024 at two HOPDs and two ASCs. Patient characteristics, operative metrics, postoperative complications, and predictors of overnight admission were analyzed. Cost analyses utilized Medicare outpatient procedure facility fees for comparison.

A total of 492 of 559 patients (88.0%) underwent same-day discharge, including all patients at ASCs. Significant predictors of any overnight admission included age > 65 (OR = 2.482, p = 0.027), living > 30 miles from the hospital (OR = 2.162, p = 0.005), bilateral surgery (OR = 2.435, p = 0.016), and afternoon PACU arrival (OR = 2.005, p = 0.028). Predictors of unplanned overnight admission were increased distance from the hospital (OR = 2.316 (1.110-4.921)), bilateral surgery (OR = 3.020 (1.110-10.613)), and afternoon PACU arrival (OR = 2.698 (1.144-7.449)). ASC patients experienced shorter postoperative stays and equivalent postoperative complications. Cost analysis demonstrated that performing identical procedures at ASCs significantly reduced facility fees (p < 0.001), yielding estimated savings of $1,785,496 (61.2%) per 99 patients compared with HOPDs.

For appropriately selected patients, SDM with reconstruction at ASCs is safe, feasible, and associated with substantial cost savings. These findings support expanded use of ASCs to optimize resource utilization without compromising patient outcomes.