Journal: Annals of surgical oncology
Study question
Among women undergoing mastectomy with immediate implant or tissue expander reconstruction, how safe, feasible, and cost‑effective is same‑day discharge from ambulatory surgery centers compared with hospital outpatient departments, and which factors predict overnight admission?
Design and setting
Retrospective review of consecutive cases (January 2023–June 2024) at two hospital outpatient departments and two ambulatory surgery centers. Cost comparison used Medicare outpatient facility fees.
Patients and procedures
Women undergoing mastectomy with immediate implant or tissue expander reconstruction. Outcomes included same‑day discharge vs overnight admission, postoperative complications, length of stay, and facility costs.
Key findings
- Utilization and discharge
- 492 of 559 patients (88.0%) were discharged the same day.
- All patients at ambulatory centers were discharged same day.
- Predictors of any overnight admission
- Age > 65 years (OR 2.482; p = 0.027)
- Living > 30 miles from the hospital (OR 2.162; p = 0.005)
- Bilateral mastectomy (OR 2.435; p = 0.016)
- Afternoon PACU arrival (OR 2.005; p = 0.028)
- Predictors of unplanned overnight admission
- Living > 30 miles away (OR 2.316; 95% CI 1.110–4.921)
- Bilateral surgery (OR 3.020; 95% CI 1.110–10.613)
- Afternoon PACU arrival (OR 2.698; 95% CI 1.144–7.449)
- Safety and efficiency
- Patients treated in ambulatory centers had shorter postoperative stays.
- Postoperative complication rates were equivalent between ambulatory centers and hospital outpatient departments.
- Cost
- Identical procedures performed in ambulatory centers had significantly lower facility fees (p < 0.001).
- Estimated savings were $1,785,496 (61.2%) per 99 patients compared with hospital outpatient settings.
Clinical implications
Same‑day mastectomy with immediate implant or tissue expander reconstruction can be safely and efficiently performed in ambulatory centers for appropriately selected patients, with comparable complications and substantial reductions in facility costs. Older age, greater travel distance, bilateral procedures, and later recovery room arrival identify patients at higher risk for needing overnight admission.