A Single-Institution Case Series of Outpatient Same-Day Mastectomy: Implementation of a Quality Improvement Project and Initiative for Enhanced Recovery After Surgery

Mohamed-Aly Bakeer; Cameron Coker; Elisa Atamian; Daniel Yoo; Radbeh Torabi; Adam I Riker

doi:10.31486/toj.20.0040

A Single-Institution Case Series of Outpatient Same-Day Mastectomy: Implementation of a Quality Improvement Project and Initiative for Enhanced Recovery After Surgery

Ochsner J. 2020 Winter;20(4):388-393. doi: 10.31486/toj.20.0040.

Authors

Mohamed-Aly Bakeer¹, Cameron Coker¹, Elisa Atamian², Daniel Yoo¹, Radbeh Torabi¹, Adam I Riker^{1

3}

Affiliations

¹ Department of Surgery, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA.
² Tulane University School of Medicine, New Orleans, LA.
³ Department of Surgery, Anne Arundel Medical Center, DeCesaris Cancer Institute, Annapolis, MD.

Abstract

Background: National data demonstrate a trend toward outpatient same-day mastectomy. The possible drivers of this change include the costs related to hospital admission and effective management of postoperative pain. We retrospectively analyzed our single-institution experience with outpatient same-day mastectomy that incorporates a multimodal pain management regimen. Methods: We retrospectively reviewed the medical records of patients who underwent same-day mastectomy at a single academic hospital. All patients received a multimodal, perioperative pain management regimen consisting of the intraoperative administration of 1,000 mg of intravenous (IV) acetaminophen and 30 mg of IV ketorolac, combined with the operating surgeon performing a 4- to 5-level, midaxillary, intercostal nerve block using liposomal bupivacaine. All patients were discharged with a prescription for acetaminophen with codeine, along with options for nonnarcotic alternatives as needed for pain. Results: We reviewed the data on 72 patients who underwent mastectomies: 11 (15.3%) bilateral and 61 (84.7%) unilateral. The average age was 57 years, and average body mass index was 30 kg/m². The average length of stay of 4 to 6 hours was a marked reduction compared to a 23-hour observational period or an inpatient hospital stay. The average follow-up was 20.1 weeks. Five patients presented to the emergency department (ED) within the 30-day postoperative period, with 2 patients (2.8%) requiring readmission to the hospital for non-pain-related issues. The other 3 patients (4.2%) were evaluated for specific pain-related issues but did not require admission and were discharged home from the ED. Conclusion: Our data support outpatient same-day mastectomy incorporating a multimodal, perioperative pain management regimen as a safe and feasible treatment option. Potential additional benefits may include decreased oral opioid use and cost savings for the hospital.

Keywords: Ambulatory surgical procedures; bupivacaine; mastectomy; nerve block; opioid-related disorders; pain management.