Initial experiences with a multidisciplinary approach to decreasing the length of hospital stay for patients undergoing unilateral mastectomy Journal Article


Authors: Weber, W. P.; Barry, M.; Junqueira, M. J.; Lee, S. S.; Mazzella, A. M.; Sclafani, L. M.
Article Title: Initial experiences with a multidisciplinary approach to decreasing the length of hospital stay for patients undergoing unilateral mastectomy
Abstract: Background: We hypothesized that the introduction of a short-stay pathway would result in a significant reduction in length of stay for patients undergoing unilateral mastectomy, without a negative impact on patient safety. Materials and methods: As part of a quality improvement project, a multidisciplinary committee designed a 1-day stay program for unilateral mastectomy patients. The study period was the first year after the 1-day pathway had routinely been implemented. We report on consecutive patients undergoing unilateral mastectomy ± tissue expander at Memorial Sloan-Kettering Cancer Center from July 1, 2009 to June 30, 2010. The primary endpoint was the percentage of patients discharged on postoperative day 1. Secondary endpoints included the incidence of postoperative complications within 30 days of surgery, reoperations, readmissions, and urgent-care visits within 7 days. Results: Over a 12-month period, 537 patients underwent unilateral mastectomy. Of those, 82.7% (444/537) were performed on a 1-day hospitalization basis, compared with 9.6% in 2008, before implementation of the 1-day plan. The 30-day complication rate was 6.1% (33/537). Overall, 2.6% of all patients had reoperation for hematoma (14/537), 0.9% had to be readmitted (5/537), and 1.5% (8/537) attended the urgent-care department. If all patients had stayed in the hospital for more than 1 day, none of the readmissions and only 2 urgent-care visits would have been prevented. Conclusions: This study shows that a 1-day stay following mastectomy is easy to implement and safe for patients if a multidisciplinary team is involved in planning and implementation. © 2011 Elsevier Ltd. All rights reserved.
Keywords: treatment outcome; middle aged; major clinical study; postoperative care; follow-up studies; prospective studies; mastectomy; incidence; breast neoplasms; time factors; postoperative complication; health care quality; length of stay; patient safety; surgical infection; hematoma; hospital stay; short-stay pathway; unilateral mastectomy
Journal Title: European Journal of Surgical Oncology
Volume: 37
Issue: 11
ISSN: 0748-7983
Publisher: Elsevier Inc.  
Date Published: 2011-11-01
Start Page: 944
End Page: 949
Language: English
DOI: 10.1016/j.ejso.2011.08.001
PROVIDER: scopus
PUBMED: 21893395
DOI/URL:
Notes: --- - "Export Date: 2 November 2011" - "CODEN: EJSOE" - "Source: Scopus"
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MSK Authors
  1. Walter Paul Weber
    4 Weber
  2. John Mitchel Barry
    9 Barry
  3. Sinda S Lee
    9 Lee