National Patterns of Hospital Admission Versus Home Recovery Following Mastectomy for Breast Cancer.

IF 3.4 2区 医学 Q2 ONCOLOGY Annals of Surgical Oncology Pub Date : 2024-12-01 Epub Date: 2024-09-25 DOI:10.1245/s10434-024-16107-w
Leah S Kim, Miranda S Moore, Eric Schneider, Joseph Canner, Haripriya Ayyala, Judy Chen, Pavan Anant, Elena Graetz, Melanie A Lynch, Gregory Zanieski, Alyssa Gillego, Monica G Valero, Ellie M Proussaloglou, Elizabeth R Berger, Mehra Golshan, Rachel A Greenup, Tristen S Park
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Abstract

Background: We examined national patterns of care and perioperative outcomes for women after mastectomy, comparing home recovery (HR) with hospital admission.

Patients and methods: Using Martketscan data (2017-2019), women ≥ 18 years old who underwent mastectomy ± reconstruction were identified and classified as either home recovery (same calendar day discharge) or hospital admission (stays > 1 calendar day). Comorbidities and receipt of chemo/immunotherapy 6 months prior to surgery and post-surgical 30-day complications were measured. Logistic regression calculated the odds of any complication by encounter type, adjusting for age, accompanying lymph node (LN) procedure, reconstruction, neoadjuvant chemo- and/or immunotherapy, and select comorbidities.

Results: Of 11,789 mastectomy encounters (N = 11,659 women), 4751 (40%) cases utilized HR while 7038 (60%) had hospital admission. HR patients were older (53.6 years old vs. 51.8 years old) with lower rates of reconstruction (60.2 vs. 74.5%, p < 0.001). Rates of neoadjuvant chemotherapy (19.6 vs. 20.9%, p = 0.099) and immunotherapy (3.6 vs. 3.9%, p = 0.445) were similar between groups. Complication rates were lower among HR patients with fewer postoperative hematomas (0.6 vs. 1.3%, p < 0.001) and decreased wound complications (8.5 vs. 9.8%, p = 0.019). In a multivariable analysis, the odds of any complication were approximately 20% lower for HR patients compared with admission patients (aOR 0.81, 95% CI 0.72-0.91, p < 0.001). Unplanned emergency room visits were similar between groups (6.7 vs. 7.2%, p = 0.374); yet fewer hospital re-admissions (2.5 vs. 3.5%, p = 0.003) occurred in women recovering at home.

Conclusion: HR is a safe option compared with in-hospital admission for clinically appropriate women after mastectomy as they are less likely to experience postoperative complications, emergency department (ED) visits, or hospitalization.

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乳腺癌乳房切除术后入院与在家康复的全国模式。
背景:我们研究了全国乳房切除术后妇女的护理模式和围手术期结果,比较了家庭康复(HR)和入院治疗:利用Martketscan数据(2017-2019年),确定了接受乳房切除术(±重建)的≥18岁女性,并将其分类为家庭康复(同一日历日出院)或入院(住院时间>1日历日)。对合并症、术前 6 个月接受化疗/免疫治疗以及术后 30 天并发症进行了测量。逻辑回归计算了不同类型并发症的发生几率,并对年龄、伴随的淋巴结(LN)手术、重建、新辅助化疗和/或免疫治疗以及选定的合并症进行了调整:在 11789 例乳房切除术中(N = 11659 名女性),4751 例(40%)使用了 HR,7038 例(60%)入院治疗。HR患者年龄较大(53.6岁对51.8岁),重建率较低(60.2%对74.5%,P 结论:与住院治疗相比,HR 是适合乳房切除术后临床妇女的安全选择,因为她们不太可能出现术后并发症、急诊科就诊或住院治疗。
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来源期刊
CiteScore
5.90
自引率
10.80%
发文量
1698
审稿时长
2.8 months
期刊介绍: The Annals of Surgical Oncology is the official journal of The Society of Surgical Oncology and is published for the Society by Springer. The Annals publishes original and educational manuscripts about oncology for surgeons from all specialities in academic and community settings.
期刊最新文献
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