Post-Mastectomy Emergency Department Visits in Alberta: Understanding Patient Perspectives

Same-day surgery for mastectomy increased in Alberta from 1.7% to 73% in 2022, after implementation of a perioperative pathway in 2016. However, rates of unplanned visits to the emergency department (ED) remained >20%. Previous research explored reasons for this using administrative data but lacked patient-level data. Our study aims to explore patient-reported factors influencing unplanned ED visits after mastectomy. A survey study was conducted of patients who underwent mastectomy in Alberta between July 2021 and June 2022. Patients were identified from the Canadian Institute of Health Information database; chart review was performed to confirm ED visit details. Survey questions evaluated medical, socioeconomic, and psychologic domains, as well as patient-reported experiences of perioperative care. Of 556 patients who underwent mastectomy during the study period, 23% presented to the ED unplanned within 30 days. The survey was sent to 87 patients meeting inclusion criteria; 38% responded. Most patients presented on a weekend, stating the ED was the only choice available at the time. The most common patient concerns were related to infection (38%) and drain function (38%). Despite high postoperative ED visit rates, overall, 84% felt prepared for surgery, only 15% felt uncomfortable with drain management, and 78% of patients were satisfied with surgery. Difficulty accessing their surgical team postoperatively was reported as the main challenge. Future initiatives should focus on improved access to outpatient care and education on post-mastectomy emergencies.