V14: Predictive Factors Associated with the Risk of Admission for Outpatient Mastectomy: a Single-institution Experience

Tuesday, March 1, 2022

6:13 PM – 6:16 PM CST

Location: Zoom Meeting

Virtual Poster Presenter(s)

Srivarshini C. Mohan, MD

Surgery Resident
Cedars Sinai Medical Center
Porter Ranch, California, United States

Disclosure: Disclosure information not submitted.

Participants should be aware of the following financial/non-financial relationships:

Srivarshini C. Mohan, MD: Disclosure information not submitted.

Introduction:

Breast cancer surgery utilizes an increasing proportion of healthcare resources on the healthcare system due to increasing mastectomy rates. Outpatient mastectomies (OM) have been shown to be viable and reduce costs compared to inpatient mastectomies (IM). In this study we identified factors predictive of an unplanned inpatient mastectomy (IM) compared to OM.

Methods:

Review of a prospective single institution database identified female patients who has planned outpatient mastectomies with expander/implant reconstruction between 2/2020-5/2021. Patient demographics, operative variables, pain management, 30-day complications, and return to care within 30 days (defined as reoperation, inpatient readmission, or emergency department visit) were assessed.

Results:

172 patients met inclusion criteria, of which 118 (68.6%) had OM. Mean age was 49.4 years (range 38.3-60.5). Mean length of stay was 17.2 hours (range 5.2-29.3). Most (87.8%) patients received post-operative blocks. Compared to OM, IM patients had higher median estimated blood loss (EBL) (150 vs 75 cc, p=0.002) and post-anesthesia care unit (PACU) pain scores ≥7 on a 1-10 scale (52.8% vs 26.3%, p=0.002). IM patients were also more likely to undergo axillary lymph node dissections (ALND) (46.3% vs 21.2%, p=0.003) and sub-pectoral expander placement (37% vs 16.9%, p=0.004). IM patients had higher rates of return to care (16.7% vs 3.4%, p=0.004) but had similar rates of surgical complications (10.2% vs 13.0%, p=0.59). On multivariable analysis, factors associated with higher odds of unplanned IM included: ALND (OR 17.26, 95% CI 1.34-222.7), higher EBL (OR 1.01, 95% CI 1.00-1.02), longer operating time (OR 1.02, 95% CI 1.00-1.04), perioperative NSAIDs (OR 341.8, 95% CI 5.52-21169.6), administration of oral acetaminophen (OR 29.67, 95% CI 1.92-457.9), and higher max PACU pain scores (OR 196.25, 95% CI 4.11-9371.54).

Conclusions: Factors predictive of unplanned IM included ALND, higher EBL, longer length of operation, higher pain scores, and administration of non-opioid pain medications. OM is a feasible option for patients undergoing expander/implant reconstruction that may reduce costs.

Learning Objectives:

Upon completion, participants will be able to describe the benefits of outpatient mastectomies.
Upon completion, participants will be able describe factors that may be predictive of an unplanned inpatient mastectomy.
Upon completion, participants will be able to describe differences between patients who underwent outpatient mastectomies versus those who underwent unplanned inpatient mastectomies in this study.