The Impact of Same-Day Discharge and Enhanced Recovery on Patient Quality of Life After Mastectomy with Implant Reconstruction

BACKGROUND

This study aimed to evaluate how enhanced recovery (ER) protocols and same-day discharge (SDD) influences patients' postoperative quality of life (QOL).

METHODS

Patients who underwent mastectomy with implant-based breast reconstruction from 2008 to 2020 were identified in a prospective database. The study assessed QOL with BREAST-Q and Was It Worth It? (WIWI) questionnaires. Responses were compared between the ER and pre-ER groups and between the SDD and hospital stay (HS) groups using one-way analysis of variance (ANOVA) and chi-square tests.

RESULTS

The inclusion criteria were met by 568 patients, with a 43% response rate, and 217 patients were included for analysis. Chest physical well-being was lower for the ER cohort, but postoperative breast satisfaction was higher. Psychosocial status, sexual well-being, and satisfaction with information given did not differ significantly between the ER group and the pre-ER or SDD group. In the compared groups, QOL did not differ significantly.

CONCLUSIONS

Enhanced recovery with SDD after mastectomy using implant-based reconstruction did not have an adverse impact on patient postoperative QOL.

Pre-mastectomy sentinel lymph node biopsy: a strategy to enhance outcomes in immediate breast reconstruction

The pre-mastectomy sentinel lymph node biopsy (PM-SLNB) is a technique that provides knowledge regarding nodal status prior to mastectomy. Because radiation exposure is associated with poor outcomes in breast reconstruction and reconstructed breasts can interfere with the planning and delivery of radiation therapy (RT), information regarding nodal status has important implications for patients who desire immediate breast reconstruction. This study explores the safety and utility of PM-SLNB as part of the treatment strategy for breast cancer patients desiring immediate reconstruction. We reviewed the charts of adult patients (≥18 years old) who underwent PM-SLNB from January 2004 to January 2011 at our institution. PM-SLNB was offered to patients with stage I or IIa, clinically and/or radiographically node-negative breast cancer who desired immediate breast reconstruction following mastectomy. PM-SLNB was also offered to patients with ductal carcinoma in situ if features concerning for invasive carcinoma were present. Ninety-one patients underwent PM-SLNB of 94 axillae. PM-SLNB was positive in 25.5% of breasts (n = 24). Nineteen node-positive patients (79.2%) have undergone or planning to undergo delayed reconstruction at our institution. Seventeen of these 19 node-positive patients (89.5%) have received adjuvant RT. Two patients (10.5%) elected against RT despite our recommendation for it. No biopsy-positive patient underwent immediate reconstruction or suffered a radiation-induced complication with their breast reconstruction. There were two minor complications associated with PM-SLNB, both in node-negative patients. This study demonstrates the utility of PM-SLNB in providing information regarding nodal status, and therefore the need for adjuvant RT, prior to mastectomy. This knowledge can be used to appropriately counsel patients regarding optimal timing of breast reconstruction.

A prospective randomized trial comparing subatmospheric wound therapy with a sealed gauze dressing and the standard vacuum-assisted closure device: a supplementary subgroup analysis of infected wounds

INTRODUCTION

Subatmospheric pressure wound therapy (SAWT) is commonly used to manage infected wounds. However, this practice remains controversial because the safety and efficacy of the technique has not been carefully documented.

METHODS

The authors assessed the safety and efficacy of a sealed gauze dressing with wall suction applied (GSUC) compared to vacuum assisted-closure (VAC), both soaked with topical antimicrobials. Subjects included 31 hospitalized patients with acutely infected wounds compared with 56 patients with noninfected wounds.

RESULTS

There were significant reductions in wound surface area and volume in both infected and noninfected groups; there was no significant difference in the rate of change observed in the GSUC vs the VAC arms of the study. In the infected group, the reduction in wound surface area was 4.4% per day for GSUC and 4.8% per day for VAC. Wound volume was 7.8% per day for GSUC, and 9.7% per day for VAC (P < 0.001 for all). Evidence of wound infection in all patients, regardless of treatment group, resolved by 96 hours of onset of treatment, and there were no complications specifically related to the use of a sealed dressing over infected wounds.

CONCLUSION

Gauze dressing with wall suction and VAC therapy can be used in selected acute, infected wounds and both methods of treatment appear to be similarly effective for reducing wound surface area and volume. .

BMP-9 induced osteogenic differentiation of mesenchymal stem cells: molecular mechanism and therapeutic potential

Promoting osteogenic differentiation and efficacious bone regeneration have the potential to revolutionize the treatment of orthopaedic and musculoskeletal disorders. Mesenchymal Stem Cells (MSCs) are bone marrow progenitor cells that have the capacity to differentiate along osteogenic, chondrogenic, myogenic, and adipogenic lineages. Differentiation along these lineages is a tightly controlled process that is in part regulated by the Bone Morphogenetic Proteins (BMPs). BMPs 2 and 7 have been approved for clinical use because their osteoinductive properties act as an adjunctive treatment to surgeries where bone healing is compromised. BMP-9 is one of the least studied BMPs, and recent in vitro and in vivo studies have identified BMP-9 as a potent inducer of osteogenic differentiation in MSCs. BMP-9 exhibits significant molecular cross-talk with the Wnt/ β-catenin and other signaling pathways, and adenoviral expression of BMP-9 in MSCs increases the expression of osteogenic markers and induces trabecular bone and osteiod matrix formation. Furthermore, BMP-9 has been shown to act synergistically in bone formation with other signaling pathways, including Wnt/ β-catenin, IGF, and retinoid signaling pathways. These results suggest that BMP-9 should be explored as an effective bone regeneration agent, especially in combination with adjuvant therapies, for clinical applications such as large segmental bony defects, non-union fractures, and/or spinal fusions.