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

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

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.

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Author information

Authors and Affiliations

  1. Surgical Oncology, Department of Surgery, Kaiser Permanente South Sacramento Medical Center, 6600 Bruceville Road, Sacramento, CA, 95823, USA

    Brooke Vuong MD, MHA & Margaret Mentakis MD

  2. Department of Surgery, The Permanente Medical Group, San Jose, CA, USA

    Amanda N. Graff-Baker MD

  3. Department of Surgery, University of California Davis Health System, Sacramento, CA, USA

    Mio Yanagisawa MD

  4. Department of Surgery, The Permanente Medical Group, Fremont, CA, USA

    Sharon B. Chang MD

  5. Department of Surgery, The Permanente Medical Group, Oakland, CA, USA

    Veronica Shim MD

  6. Department of Ophthalmology, The Permanente Medical Group, Fremont, CA, USA

    Michele Knox MD

  7. Department of Surgery, The Permanente Medical Group, Santa Rosa, CA, USA

    Lucinda Romero MD

  8. Department of Surgery, The Permanente Medical Group, Vallejo, CA, USA

    Gillian Kuehner MD

Authors
  1. Brooke Vuong MD, MHA
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  2. Amanda N. Graff-Baker MD
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  3. Mio Yanagisawa MD
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  4. Sharon B. Chang MD
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  5. Margaret Mentakis MD
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  6. Veronica Shim MD
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  7. Michele Knox MD
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  8. Lucinda Romero MD
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  9. Gillian Kuehner MD
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Corresponding author

Correspondence to Brooke Vuong MD, MHA.

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Vuong, B., Graff-Baker, A.N., Yanagisawa, M. et al. Implementation of a Post-mastectomy Home Recovery Program in a Large, Integrated Health Care Delivery System. Ann Surg Oncol 26, 3178–3184 (2019). https://doi.org/10.1245/s10434-019-07551-0

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  • DOI: https://doi.org/10.1245/s10434-019-07551-0

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