Thomas Seddon
Thomas Seddon, Aonghus Ansari, Hasan Asfour, Alexander Sim, Ahmed Eltatawy, Pavneet Kohli, Walid Sasi
Glenfield Hospital, Leicester, United Kingdom
Abstract
Introduction
The British Association of Day Surgery (BADS) recommends a day-case rate of 30% for simple mastectomies. We audited our rate in 2020 and concluded that the most instrumental factors were pre-operative planning and clear post-operative instruction for same-day discharge. We made changes and re-audited to see if our day-case rate had improved.
Methods
A retrospective analysis of 32 patients undergoing simple mastectomy +/- Sentinel Lymph Node Biopsy (SLNB) between April and August 2023 was conducted. Primary outcome was the day-case mastectomy rate. Secondary outcomes were analysing factors that affected the length of stay: pre- and post-operative planning, co-morbidities, post-operative nausea/pain, complications, and the timing of surgery.
Results
Mean age was 60 years (range 33-85). Length of stay was 0-2 days. 40.6% were discharged the same day (6.25% in 2020). The proportion of patients who are counselled in clinic to expect to go home the same day has doubled from 15.6% to 31%. The number of patients booked as day-case surgery increased from 18.2% to 53%. 65% of patients who were booked as day-case were successfully discharged the same day. Factors limiting this were pain (33%), patient preference (67%) and afternoon surgery (66%). There were no post-operative complications, and all patients had a drain placed.
Conclusion
A proactive approach to planning day-case surgery has yielded a significant rise in our day- case mastectomy rate, from 6.25% to 40.6%. Rates may be further improved by scheduling a larger proportion of cases earlier in the day, ensuring adherence to BADS recommendations.