Isha Garg
Isha Garg, Kavitha Manoharan
North Tees and Hartlepool NHS Foundation Trust, Stockton on Tees, United Kingdom
Abstract
Introduction:
Guidelines for day-case surgery 2019 by Association of Anaesthetists and BADS recommends targeting 75% of elective surgeries to be performed as day-case. BADS recommends more than 50% for mastectomies to be done as day cases. North Tees & Hartlepool NHS Foundation trust undertakes huge amount of breast cancer surgery in North East, yet lagging behind meeting the BADS standards with less than 30% being done as day-case mastectomy.
Methods:
Prospective audit was conducted on all mastectomies between January 2022 to March 2022. Data were collected on patient demographics, surgical details such as use of drain, postoperative intravenous antibiotics and anaesthetic details including mode of anaesthesia, analgesia, postoperative complications and reason for inpatient stay.
Results:
The initial audit cycle showed that a total of 46 mastectomies were performed in our trust, of which 16 were discharged as day-case and 30 stayed as in patient. The day-case compliance was only 39%. The reasons for inpatient stay was scrutinised. Apart from social factors (15.2%), there was remarkable variations in surgical practice with regards to use of drains (34.7%), postoperative antibiotics (6.5%) with some anaesthetic factors (17.3%) such as pain and nausea.
Conclusions:
Recommendations were laid to improve this, including day-case anaesthetic protocol and standardising use of drains and antibiotics postoperatively. Changes to the Trust Discharge criteria were made as per BADS recommendations to address the patient factors. The re-audit in 2023 showed remarkable improvement of day-case mastectomies to 60%.