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Langer S, Xu Y, Kong S, Puddy J, Quan ML. Investigating Factors Associated with Postmastectomy Emergency Department Visits: A Population-Based Analysis. Ann Surg Oncol 2023; 30:6499-6505. [PMID: 37454012 DOI: 10.1245/s10434-023-13727-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 05/23/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND In 2016, a multi-pronged pathway was implemented across 13 hospitals to improve the mastectomy perioperative care experience with one objective being to safely allow same day surgery mastectomy. While the pathway successfully increased same day mastectomy rates from 1.7 to 73.0%, the rate of postoperative emergency department (ED) visits remained high at > 20%, despite focused interventions to enhance perioperative support. AIM To investigate potential factors associated with high postoperative ED visits following mastectomies in Alberta, Canada. METHODS Data was collected using the Discharge Abstract Database and the National Ambulatory Care Reporting System database. Eligible patients included all women over 18 years old who underwent a mastectomy province-wide between 2004 and 2020. Patient demographics were collected. Primary outcome of interest was ED visit within 30 days of mastectomy. Univariate and multivariable analyses were performed to identify independent predictors for post-operative ED visits. RESULTS A total of 19,974 patients had mastectomy during the study period, of which 4590 (23%) had an ED visit within 30 days of surgery. Independent factors associated with ED visits were increasing age, overnight stay mastectomy, reconstruction, certain comorbidities, and living rurally. CONCLUSIONS Post-operative ED visits remain high despite initiating a province-wide surgical pathway in 2016 which emphasizes patient education and improved perioperative care and supports. Currently, the majority of ED visits are manageable in non-emergent settings. Patient populations at higher risk for ED visits groups may benefit from additional targeted support and resources to reduce unplanned ED visits.
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Affiliation(s)
- Steven Langer
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Yuan Xu
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Shiying Kong
- Alberta Health Services, Department of Analytics, University of Calgary, Calgary, Canada
| | - Jennifer Puddy
- Department of Emergency Medicine, University of Calgary, Calgary, Canada
| | - May Lynn Quan
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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The Quest for Outpatient Mastectomy in COVID-19 Era: Barriers and Facilitators. Breast J 2022; 2022:1863519. [PMID: 35711886 PMCID: PMC9186523 DOI: 10.1155/2022/1863519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/16/2022] [Indexed: 12/04/2022]
Abstract
Background The rate of inpatient mastectomies remains high despite multiple studies reporting favourably on outpatient mastectomies. Outpatient mastectomies do not compromise quality of patient care and are more efficient than inpatient care. The objective of this study was to evaluate the feasibility of outpatient mastectomy. Materials and Methods Implementation of an outpatient mastectomy program was evaluated in a retrospective study. All patients who underwent mastectomy between January 2019 and September 2021 were included. Results 213 patients were enrolled in the study: 62.4% (n = 133) outpatient mastectomies versus 37.6% (n = 80) inpatient mastectomies. A steady rise in outpatient mastectomies was observed over time. The second quarter of 2020, coinciding with the first COVID-19 wave, showed a peak in outpatient mastectomies. The only significant barrier to outpatient mastectomy proved to be bilateral mastectomy. Unplanned return to care was observed in 27.8% of the outpatient versus 36.3% of the inpatient mastectomies (P=0.198); the reason for unplanned return of care was similar in both groups. Conclusions Outpatient mastectomy is shown to be feasible and safe with a steady increase during the study period. A barrier to outpatient mastectomy was bilateral mastectomy. Incidence of unplanned return to care or complications did not differ significantly between the outpatient and inpatient cohorts.
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Keehn AR, Olson DW, Dort JC, Parker S, Anderes S, Headley L, Elwi A, Estey A, Crocker A, Laws A, Quan ML. Same-Day Surgery for Mastectomy Patients in Alberta: A Perioperative Care Pathway and Quality Improvement Initiative. Ann Surg Oncol 2019; 26:3354-3360. [PMID: 31342384 DOI: 10.1245/s10434-019-07568-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Same-day surgery (SDS) following mastectomy is safe and well accepted. Overnight admission in patients fit for discharge is an inefficient use of health resources. In response to a national review highlighting SDS following mastectomy at 1.4% in Alberta, a perioperative pathway was conceived. METHODS The pathway was implemented across Alberta at 13 hospitals beginning in 2016. A steering committee was assembled, and clinical and administrative leads at each site were identified. Opportunities along the patient care experience whereby action could be taken to promote uptake of SDS were identified. Provincially branded support materials including presentations, order sets, and standard operating procedures were developed. Nurse educators provided in-service teaching such as standardized drain care and discharge teaching. Educational booklets, group classes, and online resources were developed for patients and families. An audit of SDS rates, unscheduled return to the emergency department (ED), and readmission rates was reported to teams quarterly, allowing for iterative modifications. Patient-reported experience measures (PREMs) were collected. RESULTS SDS following mastectomy increased from 1.7 to 47.8%, releasing an estimated 831 bed days per year. No differences in unexpected return to the ED or readmission to hospital existed between SDS patients and those admitted overnight. A total of 102 patients completed the PREM survey, of whom 90% felt "excellent or good" with the plan to go home, how to care for themselves once home, and who to contact should issues arise. CONCLUSIONS Implementation of a provincial perioperative pathway improved uptake of SDS following mastectomy and demonstrated favorable PREMs.
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Affiliation(s)
- Alysha R Keehn
- Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - David W Olson
- Department of Surgery, University of Alberta, Edmonton, Canada
| | - Joseph C Dort
- Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Canada.,Department of Oncology, University of Calgary, Calgary, Canada
| | - Shannon Parker
- Cancer Strategic Clinical Network, Alberta Health Services, Edmonton, Canada
| | - Susan Anderes
- Cancer Strategic Clinical Network, Alberta Health Services, Edmonton, Canada
| | - Lynn Headley
- Cancer Strategic Clinical Network, Alberta Health Services, Edmonton, Canada
| | - Adam Elwi
- Cancer Strategic Clinical Network, Alberta Health Services, Edmonton, Canada
| | - Angela Estey
- Cancer Strategic Clinical Network, Alberta Health Services, Edmonton, Canada
| | - Alysha Crocker
- Surveillance and Reporting, Alberta Health Services, Calgary, Canada
| | - Alison Laws
- Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
| | - May Lynn Quan
- Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada. .,Department of Community Health Sciences, University of Calgary, Calgary, Canada. .,Department of Oncology, University of Calgary, Calgary, Canada.
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