Same-day Mastectomy And Immediate Prosthetic Breast Reconstruction: A Twelve-year Analysis Of A National Database And Early Postoperative Outcomes
Amanda L. Chow, B.A.1, Margaret M. Luthringer, M.D.1, Emily A. Van Kouwenberg, M.D.2, Richard L. Agag, M.D.2, Jeremy C. Sinkin, M.D.2.
1Rutgers New Jersey Medical School, Newark, NJ, USA, 2Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Purpose: COVID-19 and rising healthcare costs have incentivized shorter hospital stays after mastectomies with immediate prosthetic reconstruction. The purpose of this study was to compare postoperative outcomes following same-day and non-same day mastectomy with immediate prosthetic reconstruction.
Methods: A retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program database from 2007-2019 was performed. Patients who underwent mastectomies and immediate reconstruction with tissue expanders (TE) or implants (DTI) were selected and grouped based on length of stay. Univariate analysis and multivariate regression were performed to compare 30-day postoperative outcomes between length of stay groups.
Results: A total of 45,451 patients were included: 1,508 had same-day surgery (SDS) and 43,942 were admitted for ≥1 night (non-SDS). There was no significant difference in overall 30-day morbidity and mortality between SDS and non-SDS following immediate prosthetic reconstruction. SDS was not a predictor of morbidity (OR 1.2, P=0.214) while TE reconstruction decreased odds of morbidity compared to DTI (OR 0.76, P<0.001) (Table 1). Among patients who had SDS, BMI was significantly associated with early complications on multivariate analysis (OR 1.04, P=0.004).
Conclusions: Our study provides an up-to-date assessment of the safety of mastectomies with immediate prosthetic breast reconstruction that captures recent advancements. Postoperative complication rates are similar between same-day discharge and at least one-night stay, suggesting that same-day procedures may be safe for appropriately selected patients.
| Table 1. Multivariate Regression for Predictors of Overall 30-Day Morbidity and Mortality Following Mastectomy with Immediate Prosthetic Reconstruction | |||
| Adjusted Odds Ratio | 95% Confidence Interval | P-value | |
| Same-day Surgery | 1.155 | 0.920-1.450 | 0.214 |
| Age | 1.006 | 1.002-1.010 | 0.002 |
| BMI | 1.048 | 1.042-1.054 | <0.001 |
| Disseminated Cancer | 1.730 | 1.301-2.301 | <0.001 |
| ASA Class 3 or 4 | 1.236 | 1.122-1.362 | <0.001 |
| Smoker | 1.448 | 1.287-1.628 | <0.001 |
| Diabetes | 1.147 | 0.979-1.345 | 0.091 |
| Bleeding Disorder | 1.072 | 1.437-2.987 | <0.001 |
| Axillary Lymphadenectomy | 1.324 | 1.080-1.624 | 0.007 |
| Axillary Sentinel Lymph Node Biopsy | 0.914 | 0.841-0.994 | 0.036 |
| Bilateral Surgery | 1.054 | 0.967-1.149 | 0.234 |
| Reconstruction with TE* | 0.755 | 0.680-0.838 | <0.001 |
| Total Operative Time | 1.003 | 1.002-1.003 | <0.001 |
| BMI = body mass index; ASA = American Society of Anesthesiology; TE = tissue expander | |||
| *Reference category was reconstruction with Implant | |||
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