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25-09-2024 | Mastectomy | Global Health Services Research

National Patterns of Hospital Admission Versus Home Recovery Following Mastectomy for Breast Cancer

Authors: Leah S. Kim, MD, Miranda S. Moore, MPH, Eric Schneider, PhD, Joseph Canner, MHS, Haripriya Ayyala, MD, Judy Chen, MS, PA-C, Pavan Anant, BS, Elena Graetz, PhD, Melanie A. Lynch, MD, Gregory Zanieski, MD, Alyssa Gillego, MD, Monica G. Valero, MD, Ellie M. Proussaloglou, MD, Elizabeth R. Berger, MD, MS, Mehra Golshan, MD, MBA, Rachel A. Greenup, MD, MPH, Tristen S. Park, MD

Published in: Annals of Surgical Oncology

Abstract

Background

We examined national patterns of care and perioperative outcomes for women after mastectomy, comparing home recovery (HR) with hospital admission.

Patients and Methods

Using Martketscan data (2017–2019), women ≥ 18 years old who underwent mastectomy ± reconstruction were identified and classified as either home recovery (same calendar day discharge) or hospital admission (stays > 1 calendar day). Comorbidities and receipt of chemo/immunotherapy 6 months prior to surgery and post-surgical 30-day complications were measured. Logistic regression calculated the odds of any complication by encounter type, adjusting for age, accompanying lymph node (LN) procedure, reconstruction, neoadjuvant chemo- and/or immunotherapy, and select comorbidities.

Results

Of 11,789 mastectomy encounters (N = 11,659 women), 4751 (40%) cases utilized HR while 7038 (60%) had hospital admission. HR patients were older (53.6 years old vs. 51.8 years old) with lower rates of reconstruction (60.2 vs. 74.5%, p < 0.001). Rates of neoadjuvant chemotherapy (19.6 vs. 20.9%, p = 0.099) and immunotherapy (3.6 vs. 3.9%, p = 0.445) were similar between groups. Complication rates were lower among HR patients with fewer postoperative hematomas (0.6 vs. 1.3%, p < 0.001) and decreased wound complications (8.5 vs. 9.8%, p = 0.019). In a multivariable analysis, the odds of any complication were approximately 20% lower for HR patients compared with admission patients (aOR 0.81, 95% CI 0.72–0.91, p < 0.001). Unplanned emergency room visits were similar between groups (6.7 vs. 7.2%, p = 0.374); yet fewer hospital re-admissions (2.5 vs. 3.5%, p = 0.003) occurred in women recovering at home.

Conclusion

HR is a safe option compared with in-hospital admission for clinically appropriate women after mastectomy as they are less likely to experience postoperative complications, emergency department (ED) visits, or hospitalization.

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Title: National Patterns of Hospital Admission Versus Home Recovery Following Mastectomy for Breast Cancer
Authors: Leah S. Kim, MD
Miranda S. Moore, MPH
Eric Schneider, PhD
Joseph Canner, MHS
Haripriya Ayyala, MD
Judy Chen, MS, PA-C
Pavan Anant, BS
Elena Graetz, PhD
Melanie A. Lynch, MD
Gregory Zanieski, MD
Alyssa Gillego, MD
Monica G. Valero, MD
Ellie M. Proussaloglou, MD
Elizabeth R. Berger, MD, MS
Mehra Golshan, MD, MBA
Rachel A. Greenup, MD, MPH
Tristen S. Park, MD
Publication date: 25-09-2024
Publisher: Springer International Publishing
Keyword: Mastectomy
Published in: Annals of Surgical Oncology
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-024-16107-w

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National Patterns of Hospital Admission Versus Home Recovery Following Mastectomy for Breast Cancer

Abstract

Background

Patients and Methods

Results

Conclusion

Mastering chronic pancreatitis pain: A multidisciplinary approach and practical solutions

Keynote webinar | Spotlight on modern management of frailty

Springer Medicine

Abstract

Background

Patients and Methods

Results

Conclusion

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Mastering chronic pancreatitis pain: A multidisciplinary approach and practical solutions