One-day surgery in a series of 150 breast cancer patients: efficacy and cost-benefit analysis
Financing health-care expenditure has become increasingly more difficult. Considering the high frequency of breast cancer, which affects one million women in the world each year, the reductions of medical expenditure for the treatment of this disease is highly desirable within the limits of medical efficiency and safety. One hundred and fifty patients with carcinoma of the breast underwent surgery in our department with one-day hospitalization. Patients were discharged with the drainage tube still in place and later treated in the out-patient setting, for dressing and checking the wound, and removing the stitches and drainage tube. Four cases of seroma were registered, all resolved by aspiration of the fluid in a single visit, 1 case of haematoma and 1 case of infection. Patients who underwent this short-stay treatment were amply satisfied. Our experience demonstrates that this type of treatment is both safe and effective. Moreover, it provides considerable benefits in terms of national health-care costs as well as being psychologically better for the patients.
- [Show abstract] [Hide abstract] ABSTRACT: Over the years, the surgical management of breast cancer has become less invasive due to various factors. Breast conserving surgery and lesser axillary surgery are performed whenever possible. Early stage at diagnosis made possible by breast screening and earlier presentation of symptomatic cancers due to increased awareness has meant that more patients are undergoing breast conserving surgery. Sentinel node biopsy and axillary sampling have helped reduce arm morbidity. These changes have made breast cancer surgery more amenable to day surgery. At the same time, the benefits of early discharge and day surgery have been increasingly recognised in all surgical specialities. In 2007, when this research was undertaken, majority of breast cancer patients in Glasgow underwent operations as inpatients. The aims of this thesis were to establish the evidence base for day surgery in breast cancer and analyse the feasibility, acceptability and safety of performing day surgery in breast cancer patients in Glasgow. In Chapter 2, a systematic review of literature for studies comparing day surgery with inpatient surgery in breast cancer is presented. This was undertaken to establish the present evidence. A randomised controlled trial is the gold standard when comparing one intervention with another. However, this systematic review revealed lack of any randomised controlled trials in literature comparing day surgery with inpatient surgery for breast cancer. Only observational studies were found and these showed day surgery for breast cancer to be safe with high patient satisfaction. In Chapter 3, the feasibility of day surgery for breast cancer in Glasgow was examined. The postoperative length of hospital stay of patients undergoing surgery for breast cancer was studied across five centres in Glasgow. It was noted that 50 percent of patients were discharged within a day of their operation. An analysis of socio-demographic and clinico-pathologic factors influencing postoperative length of stay for all breast cancer surgical patients revealed that the most important factor influencing postoperative stay was the axillary procedure performed. It was seen that symptomatic cancer patients undergo more extensive surgery and are more likely to stay longer in hospital. Patients undergoing re-operations contributed 20 percent to the hospital bed utilisation. Fifty percent of the patients who were discharged within a day of their operation, were potentially thought to be suitable for day surgery. In Chapter 4, the acceptability and safety of day surgery for breast cancer, evaluated in a pilot randomised controlled trial is presented. In this trial, day surgery was compared with inpatient surgery for patients undergoing breast conserving surgery with axillary sampling or sentinel node biopsy. Physical and psychosocial outcomes were examined using validated questionnaires. In a patient satisfaction survey, day surgery was found to be highly acceptable to patients. No difference was found in the physical outcomes between the two groups. Day surgery patients were noted to have a significantly better quality of life one week after their operation. Therefore, this trial found day surgery to be a safe option. In conclusion, the results of the present thesis show that day surgery for breast cancer is a feasible option that was rated by the patients as highly acceptable and had better quality of life outcomes. Moreover, equivalent physical outcomes were noted in both the groups.
- [Show abstract] [Hide abstract] ABSTRACT: Con il termine day-surgery s'intende la possibilità clini-ca, organizzativa ed amministrativa di effettuare interventi chi-r u rgici o procedure diagnostiche e/o terapeutiche invasive e semiinvasive in regime di ricovero limitato alle sole ore del giorno, in anestesia locale, loco-regionale o generale (1) . Scopo del nostro lavoro è di valutare l'attività di day-surgery integrata nel nostro reparto di chirurgia generale. Parole chiavi: day surgery SUMMARY By attending a day surgery unit, patients are able to have an operations, in general or local anaesthesia, or minimally invasive diagnostic procedure, without the need for an overni -ght stay in Hospital. Aim of this study is to describe advantages and disvantanges of this approach by autor's experience.
- [Show abstract] [Hide abstract] ABSTRACT: Aim. Breast cancer is the most frequent malignant neoplasm in women. In Italy, 1 out of 13 women will develop breast cancer in her life. Breast cancer surgery, superficial and not implying any significant bleeding or electrolyte shifts, represents a good target for ambulatory surgery. This is particularly seen in patients with early breast cancer, candidates to conservative surgery (quadrantectomy and sentinel node biopsy), according to current standards of therapy. In the last decade, mostly in the USA and West Europe, various studies have been carried on to assess the feasibility, efficacy and complications of one day surgery regime for breast cancer. Methods. In this study, the authors examine the feasibility and efficacy of outpatient surgery for early breast cancer in the Italian context, assessing costs, benefits and the agreement of patients. They report a series of 32 women treated for breast cancer as outpatients. Results. They report a series of 32 women treated for breast cancer as outpatients at the department of general surgery of the Insubria University in Varese. Conclusions. Outpatient surgery represents a precious and safe resource only when performed in a context in which the patient is accurately prepared preoperatively and strictly controlled post-operatively. The authors, however, conclude that ambulatory surgery for early breast cancer is feasible, effective, safe, as well as satisfactory for patients in the Italian context. Also, the economic results suggest a higher affordability of the programme in comparison to hospital admissions.