Enhancing the clinical pathway for patients undergoing axillary lymph node dissection Journal Article
| Authors: | Barry, M.; Weber, W. P.; Lee, S.; Mazzella, A.; Sclafani, L. M. |
| Article Title: | Enhancing the clinical pathway for patients undergoing axillary lymph node dissection |
| Abstract: | Background: Day-case axillary lymph node dissection (ALND) is not standard practice. Here we assess the feasibility of converting this traditional inpatient procedure to an outpatient procedure without compromising the quality or continuity of patient care, identify barriers to introducing an enhanced clinical pathway based on this conversion, and report strategies employed to overcome these barriers. Methods: Consecutive patients (n= 282) undergoing ALND alone or with a concurrent breast procedure (excluding mastectomy/reconstruction) over a 12-month period were recorded in a prospective database. Assessed outcomes were successful discharge the day of surgery, early postoperative complication rates, and readmission rates. Results: From July 2009 to June 2010, 282 ALNDs were performed at Memorial Sloan-Kettering Cancer Center. 240 (85.1%) were performed as an outpatient procedure and 42 (14.9%) had inpatient ALND. The readmission rate was 0.8% (2/240), and the reoperation rate was 0.7% (2/282). Outpatient ALND procedure implementation created 240 additional beds over the 12-month study period. Identified barriers to implementing this new clinical pathway included patient expectations, reducing narcotic administration while optimizing postoperative pain control, and facilitating preoperative patient education. Conclusion: ALND may be safely performed as a day-case procedure. The key to successfully implementing ALND as a day-case procedure is a multidisciplinary team approach combined with enhanced pre and postoperative patient education. In addition, changes in the mindsets of patients and health care providers are essential. © 2011 Elsevier Ltd. |
| Keywords: | major clinical study; united states; lymph node dissection; lymph node excision; patient education; patient education as topic; breast neoplasms; postoperative complications; axillary lymph node; hospital care; patient care; patient care team; length of stay; narcotic analgesic agent; quality assurance, health care; reoperation; clinical pathway; hospital discharge; hospital readmission; axilla; hematoma; patient attitude; postoperative pain; outpatient care; continuity of patient care; axillary lymph node dissection; ambulatory surgical procedures; axillary clearance; breast cancer surgery; patient readmission; postoperative nausea; preoperative education; critical pathways |
| Journal Title: | Breast |
| Volume: | 21 |
| Issue: | 4 |
| ISSN: | 0960-9776 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2012-08-01 |
| Start Page: | 440 |
| End Page: | 443 |
| Language: | English |
| DOI: | 10.1016/j.breast.2011.10.002 |
| PROVIDER: | scopus |
| PUBMED: | 22036128 |
| DOI/URL: | |
| Notes: | --- - "Export Date: 1 August 2012" - "CODEN: BREAE" - "Source: Scopus" |
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