Immediate Post-mastectomy Implant-based Breast Reconstruction: An Outpatient Procedure?
Alexandra M. Keane, MD, Grace C. Keane, MD, Gary B. Sklonick, BS, MBA, David Chi, MD, PhD, Trina D. Ebersole, MD, Terence M. Myckatyn, MD, FACS, Marissa M. Tenenbaum, MD.
Washington University School of Medicine, St. Louis, MO, USA.
PURPOSE: Coronavirus disease 2019 (COVID-19) poses unique challenges for breast reconstruction. At our institution, COVID-19 postoperative protocols mandated patients undergoing immediate prosthetic breast reconstruction transition from 23-hour postoperative observation to same-day discharge. We sought to compare complications and hospital costs between these groups.
METHODS: A retrospective study of consecutive patients who underwent immediate prosthetic breast reconstruction from March 2019 - April 2021 at an academic hospital was performed. Before mid-March 2020, patients were admitted postoperatively for observation; after mid-March 2020, patients were discharged same day. Postoperative complications at 48 hours, 30 days, and 90 days and hospital costs were compared.
RESULTS: There were 238 patients included (119 outpatient, 119 observation). Across all time points, total complications, major complications, categorical complications (wound healing, seroma, hematoma, infection, implant exposure), and reconstructive failures were low and not statistically different between groups. There were no differences in 30-day hospital readmission/reoperation rates (7.6% outpatient vs 9.2% observation, p=0.640). No patient or surgical factors predicted major complication or hematoma by 48 hours or infection by 90 days. At 90 days, radiation history (p=0.002) and smoking (p<0.001) were significant predictors of major complications. Average patient-care costs outside of surgery-specific costs were significantly lower for outpatients ($1,509 vs $4,045, p<0.001).
CONCLUSION: Complications after immediate prosthetic breast reconstruction are low. Outpatient surgery is safe, harboring no increased risk of complications. Furthermore, outpatient care is more cost-effective. Therefore, surgeons should consider outpatient management of these patients to minimize COVID-19 exposures and reduce resource consumption, all while maintaining excellent surgical care.
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