ASBrS 2019: Comprehensive Postoperative Mastectomy Home Recovery Programs Show Patient Benefit
Comprehensive postoperative mastectomy home recovery programs significantly increased same-day patient discharge with no decrease in quality of care, according to two new studies presented at the Annual Meeting of the American Society of Breast Surgeons (ASBrS).
“Research demonstrates the safety of same-day home recovery for well-chosen patients [undergoing mastectomy]. Yet, utilization remains low,” commented Brooke Vuong, MD, of Kaiser Permanente South Sacramento Medical Center, lead author of one study. “Many women feel more comfortable recuperating in a familiar environment, and risks of hospital acquired conditions are reduced, while inpatient resources are available for higher-acuity patients.”
May Lynn Quan, MD, of the University of Calgary, lead author of the second study, noted, “Wound pain, shoulder movement, and some psychological healing have demonstrated superiority in a home environment. With proper education and support, many patients can recover and return to normal activities more quickly.”
Candian Program
With a government mandate to provide consistent quality of care and enhanced patient experience in 13 hospitals throughout the Canadian province of Alberta, Dr. Quan and her team developed a program to support home recovery as the standard of care for all patients undergoing mastectomy. The multipronged approach provided patient education about the care journey from diagnosis to survivorship, with special emphasis on postsurgical expectations and potential problems as well as pathways to access clinical feedback and care.
A mastectomy education booklet, group classes, and online resources were also developed for patients and families. From preadmission to operating and recovery room staff, the entire care team was educated about the program to ensure they understood the process and delivered consistent information.
“We found patients really wanted to go home following surgery,” said Dr. Quan. “They felt empowered to play an important role in their recovery, and hospital staff themselves became better informed about the mastectomy process.”
The program was developed and implemented across the province during an 18-month period. Data were collected for same-day patient discharge, emergency visits, and readmission. Since implementation, home recovery participation has risen from 1.2% to 40% through 2018.
Of the 102 patients participating in a voluntary postoperative survey, 91% indicated they felt “excellent or good” with the plan to go home, 93% felt “excellent or good” caring for themselves, and 93% felt “excellent or good” about knowing how to access support if needed. A standardized questionnaire designed to measure the quality of recovery 1 week following surgery on issues from pain management to the ability to eat, sleep, and care for themselves, as well as general well-being and return to routines, found an average score of 7.9/10.
U.S. Program
In 2017, The Permanente Medical Group initiated a mastectomy home recovery program across 21 medical centers with the goal of increasing home care and patient satisfaction. Single and double mastectomy, lymph node, as well as immediate implant-based reconstruction cases were included. The program began with an initial preoperative patient education session to teach skills such as drain care. The complete care team—from breast care coordinators to postanesthesia care unit recovery nurses and nurse navigators—also received training. Best practices were shared regularly across all hospitals.
The study examined home care rates and quality-of-care measures for all women undergoing mastectomy for 6 months prior to and following program implementation. Prior to the program, 165 of 626, or 26%, of mastectomies were outpatient procedures. Following implementation, 404 of 620, or 65%, were home recovery. Despite the increase in home recovery, the study found no statistical differences in emergency visits, reoperation, or readmission.
“Notably, at study launch, only 18% of mastectomies were outpatient, while during the last month in the study, the figure had risen to 79%. That reflects the tremendous satisfaction of all stakeholders in the program,” noted Dr. Vuong.
Both surgeons agree that increasing postmastectomy home care adoption is an important goal.
Disclosure: For full disclosures of the study authors, visit breastsurgeons.org.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
