Influence of physician, patient, and health care system characteristics on the use of outpatient mastectomy

Safety and Racial Implications of Same-Day Discharge in Alloplastic Breast Reconstruction Following the COVID-19 Pandemic

PURPOSE

The coronavirus disease 2019 (COVID-19) pandemic was an unprecedented period that fundamentally reshaped healthcare delivery worldwide. Among the significant changes was a shift toward same-day discharge (SDD) across all surgical specialties. This study focuses on immediate alloplastic reconstruction, with the objectives to quantify the increase in SDDs, evaluate the associated safety outcomes, and investigate racial disparities resulting from these changes.

METHODS

Using data from the National Surgical Quality Improvement Program (NSQIP) database, we conducted a retrospective analysis of patients who underwent mastectomies with immediate alloplastic reconstructions from 2018 to 2022. Patients were categorized by length of stay as SDD (0 day) or inpatient (≥1 day) and divided into pre-COVID (2018-2019) and post-COVID (2020-2022) phases. To assess patient safety, we compared complication rates between SDD and inpatient cases as well as across pre- and post-COVID periods. To evaluate racial disparities, we performed unmatched and matched comparisons of outcomes between Caucasian and Black patients. Limited statistical power precluded analysis of other racial groups.

RESULTS

A total of 31,458 patients were identified. The proportion of SDD cases increased from 9.3% pre-COVID to 31.9% post-COVID, representing a 3.43-fold rise. In this study, SDD was found to be as safe as, if not safer than, inpatient procedures, with significantly lower rates of reoperation (5.5% vs 8.6%), readmission (3.9% vs 4.9%), and postoperative transfusions (0.1% vs 1.0%) (P < 0.001). Post-COVID SDD outcomes were also comparable to pre-COVID benchmarks. Following the pandemic, racial disparities persisted in the inpatient setting, with Black patients experiencing significantly higher rates of wound dehiscence and postoperative transfusions than Caucasian patients. In contrast, among SDD cases, complication rates were similar across racial groups in the unmatched analysis, while the matched analysis revealed lower rates of surgical site complications and reoperations in Black patients.

CONCLUSIONS

Since the onset of COVID-19, SDD in immediate alloplastic reconstruction has increased by 22.6%. Despite this rapid transition, SDD has demonstrated promising outcomes, upholding both safety and equity considerations.

Factors Predicting Overnight Admission after Same-Day Mastectomy Protocol and Associated Financial Implications

BACKGROUND

Same-day mastectomy (SDM) protocols have been shown to be safe, and their use increased up to 4-fold compared with prepandemic rates. We sought to identify factors that predict overnight patient admission and evaluate the associated cost of care.

STUDY DESIGN

Patients undergoing mastectomy from March 2020 to April 2022 were analyzed. Patient demographics, tumor characteristics, operative details, perioperative factors, 30-day complication, fixed and variable cost, and contribution margin were compared between those who underwent SDM vs those who required overnight admission after mastectomy (OAM).

RESULTS

Of a total of 183 patients with planned SDM, 104 (57%) had SDM and 79 (43%) had OAM. Both groups had similar demographic, tumor, and operative characteristics. Patients who required OAM were more likely to be preoperative opioid users (p = 0.002), have higher American Society of Anesthesiology class (p = 0.028), and more likely to have procedure start time (PST) after 12:00 pm (49% vs 33%, p = 0.033). The rates of 30-day unplanned postoperative events were similar between SDM and OAM. Preoperative opioid user (odds ratio [OR] 3.62, 95% CI 1.56 to 8.40), postanesthesia care unit length of stay greater than 1 hour (OR 1.17, 95% CI 1.01 to 1.37), and PST after 12:00 pm (OR 2.56, 95% CI 1.19 to 5.51) were independent predictors of OAM on multivariate analysis. Both fixed ($5,545 vs $4,909, p = 0.03) and variable costs ($6,426 vs $4,909, p = 0.03) were higher for OAM compared with SDM. Contribution margin was not significantly different between the 2 groups (-$431 SDM vs -$734 OAM, p = 0.46).

CONCLUSIONS

Preoperative opioid use, American Society of Anesthesiology class, longer postanesthesia care unit length of stay, and PST after noon predict a higher likelihood of admission after planned SDM. OAM translated to higher cost but not to decreased profit for the hospital.

Inpatient versus Outpatient Immediate Alloplastic Breast Reconstruction: Recent Trends, Outcomes, and Safety

Background

Immediate alloplastic breast reconstruction was traditionally performed as an inpatient procedure. Despite several reports in the literature demonstrating comparable safety outcomes, there remains hesitancy to accept breast reconstruction performed as an outpatient procedure.

Methods

A retrospective review of National Surgical Quality Improvement Program data from 2014 to 2018 was utilized to evaluate recent trends and 30-day postoperative complication rates for inpatient versus outpatient immediate prosthetic-based breast reconstruction. Propensity score matching was used to obtain comparable groups.

Results

During the study period, 33,587 patients underwent immediate alloplastic breast reconstruction. Of those, 67.5% of patients were discharged within 24 hours, and 32.4% of patients had a hospital stay of more than 24 hours. Immediate alloplastic reconstruction had an overall growth rate of 16.9% from 2014 to 2018. After propensity score matching, intraoperative variables that correlated with significantly increased inpatient status included increased work relative value units (16.3 ± 2.3 versus 16.2 ± 2.6; P < 0.001), longer operative times (228 ± 86 versus 206 ± 77; P < 0.001), and bilateral procedure (44.0% versus 43.5%; P < 0.001). There were higher rates of pulmonary embolism, wound dehiscence, urinary tract infection, transfusions, sepsis, readmissions, and reoperations in the group with the longer hospital stay.

Conclusion

Based on increased complication rates and costs in the inpatient setting, we propose outpatient reconstructive surgery as a safe and cost-effective alternative for immediate alloplastic breast reconstruction.

Ensuring access to post-cancer breast reconstructions: COVID-19 lessons from the Dutch Breast Implant Registry

BACKGROUND

COVID-19 has impacted breast implant surgery for oncological and non-oncological patients worldwide. This population-based study aimed to evaluate the impact of the COVID-19 pandemic on access to reconstructive and cosmetic breast implant surgery in the Netherlands using real-world data to describe trends, and to identify lessons to prevent future capacity problems within (inter)national healthcare.

METHODS

This longitudinal study included patients undergoing breast implant surgery from the mandatory nationwide Dutch Breast Implant Registry. For 2020, the first COVID-19 wave, intermediate period, and second wave were defined. We compared data from during the pandemic to a pre-pandemic (2019) reference year, assessing differences in the number of registered breast implants, and patient and surgery-related characteristics.

RESULTS

A total of 34133 breast implants (17459 patients) were included. Compared to 2019, fewer implants were registered for post-cancer (n=484; -14.7%), cosmetic (n=480; -3.6%), and gender-affirming indications (n=104; -38.0%) during 2020. Fewer implants were registered in academic (n=196; -22.0%) and regional hospitals (n=1591; -16.5%), but more in private clinics (n=725; +10.1%). After the first wave, up to twice as many implants were registered in private clinics compared to 2019. No differences were found in characteristics of patients undergoing surgery in 2020 versus 2019.

CONCLUSION

Hospital-based reconstructive and gender-affirming surgery were heavily impacted during the pandemic, while private-clinic-based cosmetic surgery quickly recovered. These outcomes are useful to fuel discussions about how healthcare could be reorganized in times of capacity problems. We suggest exploring options to deploy private clinics for ambulatory surgery aiming to keep hospital capacity available for acutely ill patients.

Research on the Economics of Cancer-Related Health Care: An Overview of the Review Literature

We reviewed current literature reviews regarding economics of cancer-related health care to identify focus areas and gaps. We searched PubMed for systematic and other reviews with the Medical Subject Headings "neoplasms" and "economics" published between January 1, 2010, and April 1, 2020, identifying 164 reviews. Review characteristics were abstracted and described. The majority (70.7%) of reviews focused on cost-effectiveness or cost-utility analyses. Few reviews addressed other types of cancer health economic studies. More than two-thirds of the reviews examined cancer treatments, followed by screening (15.9%) and survivorship or end-of-life (13.4%). The plurality of reviews (28.7%) cut across cancer site, followed by breast (20.7%), colorectal (11.6%), and gynecologic (8.5%) cancers. Specific topics addressed cancer screening modalities, novel therapies, pain management, or exercise interventions during survivorship. The results indicate that reviews do not regularly cover other phases of care or topics including financial hardship, policy, and measurement and methods.

Same‐day mastectomy and axillary lymph node dissection is safe for most patients with breast cancer

Background and Objective

The aim of this study was to evaluate the safety of same‐day mastectomy, with or without a sentinel node biopsy (SNB) and/or axillary lymph node dissection (ALND).

Methods

In this retrospective study, we reviewed 913 consecutive women who underwent a simple mastectomy for breast cancer between the years 2014 and 2019 and were treated either with same‐day surgery (SDS) or an overnight stay (OS) regime. We reviewed all surgical complications, any unplanned return to care (RTC) and the rehospitalization rate for 30 postoperative days.

Results

A total of 259 patients (28%) were treated with SDS and 654 patients (72%) with an OS regime. There was no difference in RTC (odds ratio: 0.79 [95% confidence interval: 0.53–1.18], p = 0.26) or any major complications between the groups. None of the investigated subgroups, such as patients with previous neoadjuvant therapy, diabetes, obesity (up to a body mass index of 40 kg/m²), the American Society of Anaesthesiologist Class of 3, or elderly patients aged 75–84 years, showed an increased complication rate when treated with the SDS regime.

Conclusion

A same‐day simple mastectomy is safe with SNB and/or ALND. It can be performed safely for most patients with stable co‐morbidities.

Breast Reconstruction during the COVID-19 Pandemic: A Systematic Review

Introduction

The COVID-19 pandemic posed unique challenges for breast reconstruction. Many professional organizations initially placed restrictions on breast reconstruction, leading surgeons to conceive innovative protocols for offering breast reconstruction. This study reviewed the current evidence on breast reconstruction during the COVID-19 pandemic to provide guidance for surgeons facing future crises.

Methods

The MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews were searched for studies (1) describing implant and autologous breast reconstruction following mastectomy and (2) occurring during or pertaining to the COVID-19 pandemic.

Results

Of the 1347 studies identified, 26 were included. Studies discussed type of reconstruction (18, 69%), complications (11, 42%), timing of reconstruction (10, 38%), protocols (10, 38%), COVID-19 screening (7, 27%), and length of hospital stay (7, 27%). The type of reconstruction varied depending on the stage of the pandemic: early on, autologous breast reconstruction was halted to preserve resources, but was later resumed. Within implant-based reconstruction, direct-to-implant was favored over serial tissue expansion. Several protocols were developed, with many emphasizing multidisciplinary collaborations for patient selection, use of specialized measures to reduce risk of COVID-19 transmission, and optimization of same-day discharge. Complication rates following breast reconstruction were similar to pre-pandemic rates.

Conclusions

The COVID-19 pandemic has forever changed the landscape of breast reconstruction by raising important questions about delivery of care, cost, and resource utilization. The findings of this review may inform surgeons as they plan for similar future crises or strive for improved patient care and efficacy even during nonpandemic times.

Use of machine learning to predict clinical decision support compliance, reduce alert burden, and evaluate duplicate laboratory test ordering alerts

Objectives

While well-designed clinical decision support (CDS) alerts can improve patient care, utilization management, and population health, excessive alerting may be counterproductive, leading to clinician burden and alert fatigue. We sought to develop machine learning models to predict whether a clinician will accept the advice provided by a CDS alert. Such models could reduce alert burden by targeting CDS alerts to specific cases where they are most likely to be effective.

Materials and Methods

We focused on a set of laboratory test ordering alerts, deployed at 8 hospitals within the Partners Healthcare System. The alerts notified clinicians of duplicate laboratory test orders and advised discontinuation. We captured key attributes surrounding 60 399 alert firings, including clinician and patient variables, and whether the clinician complied with the alert. Using these data, we developed logistic regression models to predict alert compliance.

Results

We identified key factors that predicted alert compliance; for example, clinicians were less likely to comply with duplicate test alerts triggered in patients with a prior abnormal result for the test or in the context of a nonvisit-based encounter (eg, phone call). Likewise, differences in practice patterns between clinicians appeared to impact alert compliance. Our best-performing predictive model achieved an area under the receiver operating characteristic curve (AUC) of 0.82. Incorporating this model into the alerting logic could have averted more than 1900 alerts at a cost of fewer than 200 additional duplicate tests.

Conclusions

Deploying predictive models to target CDS alerts may substantially reduce clinician alert burden while maintaining most or all the CDS benefit.

Satisfaction Outcomes in Women Who "Choose to Go Flat" After Mastectomy: An Integrative Review

A considerable number of women undergoing mastectomies are "choosing to go flat," forgoing reconstruction. This integrative review sought to identify satisfaction outcomes and relevant factors among these women. Using variations of the key word "going flat," a systematic search of 7 databases was conducted. Fifteen articles met the inclusion criteria and were reviewed. Decisional and breast/chest appearance satisfaction in women who did not have reconstruction was mixed when compared with other surgical options. Body image, body mass index, radiation therapy, and access to information/resources affected satisfaction. Nurses are in a pivotal role to address the communication and informational needs of these women to support optimal surgical decision-making processes and improve patient satisfaction and clinical outcomes.

What Really Matters? Organizational Versus Regional Determinants of Hospitals Providing Medical Service Centres

By adding medical service centres (MSCs) to their range of services, hospitals can participate in the outpatient sector. The aim of the MSC guideline (2004) was to ensure high quality health care in rural areas. It is unknown if organizational or regional factors influence hospitals providing services via MSCs. Our analyses focus on the identification of factors that explain the operation of an MSC by hospitals. The data are based on the mandatory structured quality reports of German hospitals (n = 1,605). These organizational data (teaching status, size and ownership) are supplemented by settlement structure and contextual data (e.g., location, doctor density). We estimated a cross-sectional multilevel logistic regression model to identify determinants of hospitals operating MSCs. In 2017, 27% of 1,605 hospitals had one or more MSCs. On an organizational level, for-profit ownership (-) and the number of beds (+) were significant determinants of providing MSCs. The analyses show that the interaction between settlement structure and ownership has an influence on the operation of an MSC. Organizational factors determine the provision of MSCs, with regional determinants playing a role as well. This indicates that hospital behaviour is difficult to predict and that individual factors shape both profit orientation and responsibility for sufficient health care in the region.

Outpatient Mastectomy: Factors Influencing Patient Selection and Predictors of Return to Care

Background

After implementation of the Surgical Home Recovery (SHR) initiative for mastectomy within a large, integrated health delivery system, most patients are discharged on the day of the procedure. We sought to identify predictors of SHR and unplanned return to care (RTC).

Study Design

Mastectomy cases with and without reconstruction from October 2017 to August 2019 were analyzed. Patient characteristics, operative variables, and multimodal pain management were compared between admitted patients and SHR patients using logistic regression. We identified predictors of RTC in SHR patients, defined as 7-day readmission, reoperation, or emergency department visit.

Results

Of 2,648 mastectomies, 1,689 (64%) were outpatient procedures and the mean age of patients was 58.5 years. Predictors of SHR included perioperative IV acetaminophen (odds ratio [OR] 1.59; 95% CI, 1.28 to 1.97), perioperative opiates (OR 1.47; 95% CI, 1.06 to 2.02), and operation performed by a high-volume breast surgeon (OR 2.12; 95% CI, 1.42 to 3.18). Bilateral mastectomies (OR 0.70; 95% CI, 0.54 to 0.91), immediate reconstruction (OR 0.52; 95% CI, 0.39 to 0.70), and American Society of Anesthesiologists class 3 to 4 (OR 0.69; 95% CI, 0.54 to 0.87) decreased the odds of SHR. Of SHR patients, 111 of 1,689 patients (7%) experienced RTC. Patients with American Society of Anesthesiologists class 3 to 4 (OR 2.01; 95% CI, 1.29 to 3.14) and African American race (OR 2.30; 95% CI, 1.38 to 4.91) were more likely to RTC; receiving IV acetaminophen (OR 0.56; 95% CI, 0.35 to 0.88) and filling an opiate prescription (OR 0.51; 95% CI, 0.34 to 0.77) decreased the odds of RTC.

Conclusions

Surgeon volume and multimodal pain medication increased the odds of SHR. Within the SHR group, American Society of Anesthesiologists Class 3 to 4 and African American patients increased the likelihood of RTC. This study helps optimize patient selection and perioperative practice for successful SHR.

High-Efficiency Same-Day Approach to Breast Reconstruction During the COVID-19 Crisis

PURPOSE

As our hospitals conserve and re-allocate resources during the COVID-19 crisis, there is urgent need to determine how best to continue caring for breast cancer patients. During the time window before the COVID-19 critical peak and particularly thereafter, as hospitals are able to resume cancer operations, we anticipate that there will be great need to maximize efficiency to treat breast cancer. The goal of this study is to present a same-day protocol that minimizes resource utilization to enable hospitals to increase inpatient capacity, while providing care for breast cancer patients undergoing mastectomy and immediate breast reconstruction during the COVID-19 crisis.

METHODS

IRB exempt patient quality improvement initiative was conducted to detail the operationalization of a novel same-day breast reconstruction protocol. Consecutive patients having undergone immediate breast reconstruction were prospectively enrolled between February and March of 2020 at Massachusetts General Hospital during the COVID-19 crisis. Peri-operative results and postoperative complications were summarized.

RESULTS

Time interval from surgical closure to patient discharge was 5.02 ± 1.29 h. All patients were discharged home, with no re-admissions or emergency department visits. No postoperative complications were observed.

CONCLUSION

This report provides an instruction manual to operationalize a same-day breast reconstruction protocol, to meet demands of providing appropriate cancer treatment during times of unprecedented resource limitations. Pre-pectoral implant-based breast reconstruction can be the definitive procedure or be used as a bridge to autologous reconstruction. Importantly, we hope this work will be helpful to our patients and community as we emerge from the COVID-19 pandemic.

Effect of Surgeon Factors on Long-Term Patient-Reported Outcomes After Breast-Conserving Therapy in Older Breast Cancer Survivors

BACKGROUND

The effect of surgeon factors on patient-reported quality-of-life outcomes after breast-conserving therapy (BCT) is unknown and may help patients make informed care decisions.

METHODS

We performed a survey study of women aged ≥ 67 years with non-metastatic breast cancer diagnosed in 2009 and treated with guideline-concordant BCT, to determine the association of surgeon factors with patient-reported outcomes. The treating surgeon was identified using Medicare claims, and surgeon factors were identified via the American Medical Association Physician Masterfile. The primary outcome was patient-reported cosmetic satisfaction measured by the Cancer Surveillance and Outcomes Research Team (CanSORT) Satisfaction with Breast Cosmetic Outcome instrument, while secondary outcomes included BREAST-Q subdomains. All patient, treatment, and surgeon covariables were included in a saturated multivariable linear regression model with backward elimination applied until remaining variables were p < 0.1.

RESULTS

Of 1650 women randomly selected to receive the questionnaire, 489 responded, of whom 289 underwent BCT. Median age at diagnosis was 72 years and the time from diagnosis to survey was 6 years. The mean adjusted CanSORT score was higher for patients treated by surgical oncologists than patients treated by non-surgical oncologists (4.01 [95% confidence interval [CI] 3.65-4.38] vs. 3.53 [95% CI 3.28-3.77], p = 0.006). Similarly, mean adjusted BREAST-Q Physical Well-Being (91.97 [95% CI 86.13-97.80] vs. 83.04 [95% CI 80.85-85.22], p = 0.006) and Adverse Radiation Effects (95.28 [95% CI 91.25-99.31] vs. 88.90 [95% CI 86.23-91.57], p = 0.004) scores were better among patients treated by surgical oncologists.

CONCLUSIONS

Specialized surgical oncology training is associated with improved long-term patient-reported outcomes. These findings underscore the value of specialized training and may be useful to patients choosing their care team.

Major ambulatory surgery in breast diseases

INTRODUCTION

The use of ambulatory surgery (AS) for breast pathology (BP) has increased. The objective of this study is to analyse a group of patients treated surgically for breast pathology in order to evaluate its quality and security in a MAS setting in 2017.

METHODS

A retrospective review of all patients undergoing breast surgery was conducted within an AS programme from January to December 2017 in Consorcio Hospital General Universitario of Valencia (CHGUV). The study analysed the number of patients, exclusion reasons, type of surgical procedures, evolution of substitution rate (SR), rate and causes of conversion to admission, postoperative complications, motives for not being included in the ambulatory programme and the satisfaction rate of the patients treated with ambulatory surgery. This has been compared with a 2013 group.

RESULTS

In 2017, 396 procedures for BP were performed: 170 for benign and 226 for malignant disease. The SR for the global mammary pathology was 72.8%. The SR for benign pathology was 93.4% and the SR for malignant pathology was 57.2%, which has increased in recent years from 45.4% in 2013. The unexpected hospitalization rate (HR) of malignant pathologies was 14.1%, while the HR in benign pathologies was 0.6%. Patients hospitalized for malignant pathologies presented higher complications (17%) than ambulatory patients (8.5%) and benign pathologies (6.5%).

CONCLUSIONS

At the CHGUV, the SR has steadily increased in malignant pathologies. The unexpected hospitalization rate is determined by perioperative sentinel lymph node biopsy results. AS for the treatment of mammary pathology is efficient and safe.

Implementation of a Post-mastectomy Home Recovery Program in a Large, Integrated Health Care Delivery System

BACKGROUND

The number of outpatient mastectomies, with and without reconstruction, has increased nationwide. In well-selected patient populations, same-day surgery for mastectomy is a safe option. A pilot project was initiated within the Kaiser Permanente Northern California healthcare system to facilitate surgical home recovery (SHR) for mastectomy patients, including patients undergoing implant-based reconstruction and bilateral mastectomies.

METHODS

Surgical home recovery for mastectomy patients was implemented in October 2017. Specific measures in this initiative included management of patient expectations at initial consultation, education about postoperative home care, multimodality pain management, and timely post-discharge follow-up. All patients undergoing mastectomy were included, except those undergoing autologous tissue reconstructions. After a 6-month implementation period, rate of same day discharge over 6 months was compared before and after the SHR initiative. We also compared emergency department (ED) visits, reoperations, and readmissions within 7 days.

RESULTS

Twenty-one medical centers participated in this initiative. Before implementing SHR, 164 of the 717 (23%) mastectomies were outpatient procedures, compared with 403 of the 663 (61%) after the implementation period. Although the rate of outpatient mastectomy increased significantly, there were no statistically significant differences in ED visits (5.2% vs. 5.1%, p = 0.98), reoperation (3.5% vs. 3.5%, p = 0.99), or readmission rates (1.4% vs. 2.7%, p = 0.08).

CONCLUSIONS

By implementing standard expectations and sharing best practices, there was a significant increase in the rate of home recovery for mastectomy without compromising quality of patient care. The success of this pilot program supports SHR for mastectomy.

[Mastectomy in ambulatory hospitalization or 24hours: Feasibility, satisfaction and preferences of the patients]

The aim of this study is to analyze the feasibility of ambulatory hospitalization or 24hours hospitalization for breast cancer treatment by mastectomy, as well as the satisfaction and the preferences of patients with regard to these ways of hospitalization.

METHODS

This observational retrospective study listed the patients operated for breast cancer who had required a mastectomy at the institute Paoli-Calmettes between the 1st of January 2013 and June 30th, 2015. A questionnaire of satisfaction was proposed to the patients regarding their mode of hospitalization.

RESULTS

One hundred and thirteen patients were included among which 29 were in the ambulatory group and 84 in the 24hours hospitalization group. The complications were represented by the rate of hematomas (3.5 %), which required a surgical resumption for two of the patients in the 24hours hospitalization group and for one patient in the ambulatory group (P=0.75). Patient's satisfaction rate was globally high: 72.7 % regardless of the mode of hospitalization (P=0.064).

CONCLUSION

The realization of mastectomy in ambulatory hospitalization seems feasible when the organization in pre- and postoperative is anticipated with a high degree of satisfaction of the patients. The psychological impact of this radical surgery seems to be a factor to be taken into account and requires a meticulous selection of the patients.

The safety of same-day breast reconstructive surgery: An analysis of short-term outcomes

BACKGROUND

We sought to examine the safety of same-day breast reconstructive (BR) surgery.

METHODS

An analysis of the American College of Surgeons, National Surgical Quality Improvement Program (ACS-NSQIP) files was performed. Patients undergoing BR for breast cancer were examined, excluding those with high-risk co-morbidities or concurrent surgery. A propensity score was calculated and a multivariable logistic regression analysis was used to calculate the difference in 30-day complications between those undergoing SDS versus longer hospital stay.

RESULTS

The study consisted of 21,539 patients; 17,449 had implant and 4090 had autologous breast reconstruction. 1195 (5.5%) underwent SDS, whereas 20,344 (94.5%) were admitted at least overnight. On unadjusted analysis, the rate of post-operative complications was nearly three times higher in those admitted compared to those undergoing SDS (6.7% vs. 2.5%; p < 0.001). On propensity score adjusted multivariable regression there was no significant difference in complications amongst those undergoing SDS versus staying in hospital (OR 1.4 (95%CI: 0.9, 2.2)).

CONCLUSIONS

These results suggest that admitting BR patients does not prevent short-term complications and same day BR surgery is safe when co-morbidities are accounted for.