D64. Investigating Same-Day Discharge For Postmastectomy Immediate Breast Reconstruction: A National Surgical Quality Improvement Program Study

Abstract

PURPOSE: Patients undergoing immediate breast reconstruction with tissue expanders are frequently admitted postoperatively for monitoring and pain control, though with additional costs and risks of nosocomial infection. If proven safe, same-day discharge could conserve resources, mitigate risk, and return patients home for faster recovery. We used large data sets to investigate the safety of same-day discharge after mastectomy with immediate postoperative expander placement. METHODS: We performed a retrospective review of patients in the National Surgical Quality Improvement Program (NSQIP) database who underwent tissue expander breast reconstruction between 2005 and 2019. Patients were grouped based on date of discharge. Demographic information, medical comorbidities, and outcomes were recorded. Statistical analysis was performed to determine efficacy of same-day discharge and identify factors predicting complication. RESULTS: Of the 14,387 included patients, 10% were discharged same-day, 70% postoperative day 1, and 20% later. Common complications such as infection, reoperation, and readmission trended upward with length of stay (6.4% v 9.3% v 16.8%), though were statistically equivalent between same-day and next-day discharge in both unilateral and bilateral surgeries. Patients discharged later had significantly more comorbidities than same or next-day discharge counterparts, and statistically higher complications rates. Predictors of complication included hypertension, smoking, diabetes, and obesity. CONCLUSION: This study demonstrates that same-day discharge after immediate tissue expander reconstruction has equivalent risk of perioperative complications as next-day discharge. For the otherwise healthy patient, going home the day of surgery is a safe option that minimizes costs and optimizes recovery while preserving postoperative outcomes.