Same-Day Mastectomy Home Recovery Programs Benefit Patients with No Increased Risks
Comprehensive post-operative mastectomy home recovery programs significantly increased same-day patient discharge with no decrease in quality-of-care in two new studies presented at the annual meeting of The American Society of Breast Surgeons in April.
“Research demonstrates the safety of same-day home recovery for well-chosen mastectomy patients. Yet, utilization remains low,” comments Brooke Vuong, MD of Kaiser Permanente South Sacramento Medical Center, lead author of one study. “Many women feel more comfortable recuperating in a familiar environment, and risks of hospital acquired conditions are reduced, while inpatient resources are available for higher acuity patients.”
May Lynn Quan, MD of University of Calgary, lead author of the second study, notes, “Wound pain, shoulder movement and some psychological healing have demonstrated superiority in a home environment. With proper education and support many patients can recover and return to normal activities more quickly.”
With a government mandate to provide consistent quality-of-care and enhanced patient experience in 13 hospitals throughout the Canadian province of Alberta, Dr. Quan and her team developed a program to support home recovery as the standard-of-care for all mastectomy patients. The multi-pronged approach provided patient education about the care journey from diagnosis to survivorship with special emphasis on post-surgical expectations and potential problems as well as pathways to access clinical feedback and care.
A mastectomy education booklet, group classes and online resources also were developed for patients and families. From pre-admission to operating and recovery room staff, the entire care team was educated about the program to ensure they understood the process and delivered consistent information.
“We found patients really wanted to go home following surgery,” says Dr. Quan. “They felt empowered to play an important role in their recovery, and hospital staff themselves became better informed about the mastectomy process.”
The program was developed and implemented across the province during an 18-month period. Data was collected for same-day patient discharge, emergency visits and readmission. Since implementation, home recovery participation has risen from 1.2% to 40% through 2018. Of the 102 patients participating in a voluntary post-operative survey, 91% indicated they felt “excellent or good” with the plan to go home, 93% felt “excellent or good” caring for themselves, and 93% felt “excellent or good” about knowing how to access support if needed. A standardized questionnaire designed to measure the quality of recovery one week following surgery on issues from pain management to the ability to eat, sleep and care for themselves, as well as general well-being and return to routines, found an average score of 7.9/10.
In 2017, The Permanente Medical Group initiated a mastectomy home recovery program across 21 medical centers with the goal of increasing home care and patient satisfaction. Single and double mastectomy, lymph node as well as immediate implant-based reconstruction cases were included. The program began with an initial pre-operative patient education session to teach skills such as drain care. The complete care team, from breast care coordinators to post-anesthesia care unit recovery nurses and nurse navigators, also received training. Best practices were shared regularly across all hospitals.
The study examined home care rates and quality-of-care measures for all women undergoing mastectomy for six months prior to and following program implementation. Prior to the program, 165 of 626 or 26% of mastectomies were outpatient procedures. Following implementation, 404 of 620 or 65% were home recovery. Despite the increase in home recovery, the study found no statistical differences in emergency visits, reoperation or readmission.
“Notably,” adds Dr. Vuong, “at study launch only 18% of mastectomies were outpatient, while during the last month in the study, the figure had risen to 79%. That reflects the tremendous satisfaction of all stakeholders in the program.”
Both surgeons agree that increasing post-mastectomy home care adoption is an important goal.