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Home recovery program feasible following mastectomy
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A comprehensive home recovery program for women who undergo mastectomy dramatically increased rates of same-day patient discharge after surgery with no decrease in quality of care, according to study results presented at American Society of Breast Surgeons Annual Meeting.
Additionally, researchers found that the perioperative care pathway and quality improvement initiative implemented in Alberta to support same-day surgery after mastectomy saved an estimated 1,031 bed days.
“Same-day surgery following mastectomy has been proven to be safe and favored by women for improved recovery at home in the comfort of their family,” May Lynn Quan, MD, general surgeon at Foothills Medical Centre in Calgary and associate professor at University of Calgary, said during a webcast. “A quality report card on breast cancer delivery was published that showed our province in [Alberta, Canada]... had an extremely low same-day mastectomy rate of about 1% compared to almost 50% elsewhere. This led us to really examine what was happening in our province with regard to how patients were being managed in the perioperative setting.”
Researchers designed the home recovery program in Alberta in 2015 to support three groups: surgeons and nurse navigators; perioperative nurses; and patients and caregivers. It included an education booklet, group classes and online resources.
Five regional committees — each with six to eight local members including a breast surgeon, nurse navigator and hospital operational leads — implemented the program over 18 months.
“We developed provincially branded materials in the form of a booklet called ‘Your Journey through Breast Cancer,’ which is available online and in paper so that all patients, no matter where they live, had access to the same education on breast cancer, breast cancer surgery, and common complications that we found are most likely to result in most patients ending up in [the ED] and other unanticipated visits,” Quan said.
Each perioperative team received in-service teaching from two dedicated nurse educators at 13 hospitals in the province.
Following the implementation of the program, same-day surgery rates for mastectomy in Alberta increased from 1.2% to 40% between 2017 and 2018, resulting in the release of an estimated 1,031 bed days.
A total of 102 patients who underwent same-day surgery following mastectomy volunteered to fill out a survey about their experiences with the new program.
An overwhelming majority (91%) reported that they felt “excellent or good” with the plan to go home. Also, 93% felt “excellent or good” caring for themselves at home and 93% felt “excellent or good” about knowing who to contact or where to get support if needed.
Results of a quality of recovery (QoR-15) questionnaire to evaluate subjective recovery 1 week after surgery showed a mean response across domains of 7.9 out of 10.
“We were able to demonstrate that a provincial initiative resulted in an improvement in same-day surgery for mastectomy and importantly the patient experience,” Quan said. “We feel that same-day surgery following mastectomy and using this implementation method is a safe and feasible way to improve the quality of care for all women in our province and out of jurisdiction.” – by John DeRosier
Reference:
Keehn A, et al. Same-day surgery for mastectomy patients in Alberta: A perioperative care pathway and quality improvement initiative. Presented at: American Society of Breast Surgeons Annual Meeting; April 30-May 5, 2019; Dallas.
Disclosures: HemOnc Today could not confirm the authors’ relevant financial disclosures at time of reporting.
Perspective
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Hank Schmidt, MD, PhD
This is a great thing for patients. It minimizes their time in the hospital, which decreases their risk for perioperative complications, most notably infections. We also expect these same-day surgery programs to offer cost savings for overall health care expenditures for breast cancer.
Health care centers want to maximize their capacity for care, so not only is this advantageous from a patient safety standpoint, but also will help hospitals expand bed availability.
These programs are already expanding in the United States. Several hospitals across the country have been investigating and adopting same-day surgery and pathways for patients undergoing mastectomy. With examples such as this study from Alberta we are likely to see home recovery programs proliferate.
The abstract indicates that this offered an advantage in terms of available bed days and patient-reported outcomes, and it will be interesting to see the results from other quality measures, such as emergency visits and readmission rates, once this program is fully implemented.
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