Same Day Discharge Following Mastectomy and Immediate Tissue Expander Reconstruction: The Effect of Patient Expectations

Background and Purpose Within, we compare the short-term outcomes of patients receiving same day mastectomy and tissue expander reconstruction for those discharged on postoperative day one versus those discharged immediately following surgery to explore the safety, efficacy, and potential impact on hospital processes. Methods This was a retrospective review of patients undergoing mastectomy with immediate TE reconstruction from March 2019 to March 2021. Patients were stratified into two cohorts; observation overnight (OBS), and discharge on same day of surgery (DC). Results In total, 153 patients underwent 256 mastectomies with immediate TE reconstruction. All patients were female and mean age was 48 years old. The DC cohort contained 71 patients (125 mastectomies) and there were 82 Patients (131 mastectomies) within the OBS cohort.On average the DC cohort had a lower BMI than the OBS group (mean ± SD; DC 26.8kg/m2 ± 5.3kg/m2, OBS 28.7kg/m2 ± 6.1kg/m2, p = 0.05), the DC cohort had higher rates of adjuvant chemotherapy (DC 40.1%, OBS 23.2%, p=0.02), and were more likely to undergo bilateral TE reconstruction (DC 76%, OBS 60%, p=0.03) than the OBS group. No differences were observed between cohorts in complication rates regarding primary or secondary outcomes. Conclusion These findings indicate that it is safe and effective within the immediate 7-day post-operative period to immediately discharge patients undergoing mastectomy with immediate TE reconstruction. Additionally, alteration of patient management practices can have a profound impact on the operational flow within hospitals.