A study by Kaiser Permanente shows that patients with mastectomy recover safely at home

A study by Kaiser Permanente shows that patients with mastectomy recover safely at home

New research shows that the majority of patients with Kaiser Permanente Northern California mastectomy now go home the same day, without an increased risk of postoperative complications.

Brooke Vuong, MD, author of the Annals of Surgical Oncology study

"Patient comfort is a big part of this initiative," said MD Brooke Vuong, lead author and cancer surgeon at Kaiser Permanente Medical Center in Southern Sacramento. "Patients often want to go home. They can sleep in their own bed and have the opportunity to recover in their familiar environment. "

Several years ago, Kaiser Permanente surgeons launched an integrated program of post-operative best practices at 21 medical centers in the Northern California area to help most patients with mastectomy recover from home the same day.

A new study by the Annals of Surgical Oncology, "Implementing a Post-Mastectomy Home Recovery Program in a Large-Scale Integrated Health Care System," now shows that home recovery rates after mastectomy increased from 23% to 61% across the region. 6 months after the start of the program, there will be no significant changes in emergency medical department visits, reoperation, or readmissions.

Gillian Kuehner, MD, Senior Author and Surgeon, Kaiser Permanente Vallejo Medical Center

"This is the first large-scale study evaluating a home recovery program for mastectomy patients," said Gillian Kuehner, senior author and surgeon at MD Kaiser Permanente Vallejo Medical Center. "We found that our Kaiser Permanente patients are grateful for the opportunity to recover safely at home."

The Northern California Breast Clinical Performance Team developed a new procedure for home post-mastectomy recovery with Kaiser Permanente's successful enhanced postoperative healing (ERAS). The team included surgeons, breast care coordinators, anesthesia providers and rehabilitation nurses.

Margaret Mentakis, MD, co-author and surgeon of Kaiser Permanente Medical Center in Southern Sacramento

"The team will ensure that patients with mastectomy are as well prepared for surgery at home after surgery as they are for surgery," said Margaret Mentakis, co-author of the study and surgeon at Kaiser Permanente Medical Center in South Sacramento.

"We make sure that patients receive excellent pain management and thorough preoperative training, and that they know how to access their providers in an hour," said Dr. Kuehner. "We work closely with all members of the medical center breast care team to ensure patient preparation."

To better understand the surgical recovery program for mastectomy patients, clinicians reviewed the 6-month periods before and after the program was implemented in October 2017.

The study included all mastectomies performed at Katerstan's Permanente Northern California Hospital 21 with and without reconstruction, with the exception of autologous tissue reconstruction, where tissue from another part of the body is used to reconstruct the breast. About 93% of the patients with mastectomy in the study had a diagnosis of cancer.

The 85-year-old surgeon performed 1,380 mastectomies over a 1-year training period; 24.9% of the mastectomies were bilateral and 31.5% underwent immediate reconstruction with implants.

Before the program, 22.9% of 717 mastectomies were outpatient, 60.8% of 663 mastectomies were followed; there were no significant differences in the rates of readmission, reoperation or readmission of the emergency department.

"It has long been common practice for surgical patients to be hospitalized after surgery and sent home the next morning," said Dr. Vuong. "As surgeons, we visit our patients the next morning and they are ready to go. Wondering what the benefits of staying overnight are? "

Currently, more than 85% of Northern California mastectomy patients recover at home after surgery. Patients with mastectomy will continue to be hospitalized as needed, including for anxiety, difficulty controlling pain, or other postoperative complications.

"This study was proof of the concept that home recovery is a safe option for most of our mastectomy patients," said Dr. Vuong.

In addition, Drs. Vuong, Kuehner, and Mentakis, co-authors of the study were Amanda N. Graff-Baker, MD, Sharon B. Chang, MD, Veronica Shim, MD, Michele Knox, MD, and Lucinda Romero, MD, all from The Permanente Medical Group; and Mio Yanagisawa, MD, of the University of California, Davis, Health System.

I am glad that you mentioned that post-mastectomy care can be well prepared and will help to set patients' expectations for early recovery at home. My sister was diagnosed with breast cancer and is expected to see a breast doctor for a mastectomy. Maybe he'll be able to recover quickly and be ready for what to expect.

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