Authors (including presenting author) :
Wong L(1), Suen TKD(1), Chu K(2), Kwong A(1)
Affiliation :
(1) Department of Surgery, Queen Mary and Tung Wah Hospital
(2) Department of Anesthesiology, Tung Wah Hospital
Introduction :
Traditionally patients after breast cancer surgery was admitted for in-patient care postoperatively. Breast cancer surgery has become less invasive and potential candidates for day procedure. A systemic review concluded day surgery for breast cancer is safe with high patient satisfaction and psychological well-being.
Objectives :
In view of the benefits to both the patient and the hospital, a program to perform selected breast cancer operations as day procedure was introduced in Tung Wah Hospital.
Methodology :
The program was formulated with the collaboration of the Departments of Anesthesiology and Surgery at Tung Wah Hospital. Lumpectomy and/or sentinel node biopsy under general anesthesia were the selected procedures.
Patients were referred to a pre-anesthetic clinic where the decision on day surgery or inpatient care was made on an individual basis. A checklist of medical and social criteria was needed to be satisfied before day surgery was decided.
After surgery, patients were assessed for fitness to be discharged on the same day. Information package were given to patients upon discharge.
Clinical indicators as recommended by the International Association for Ambulatory Surgery (IAAS) were recorded for quality assurance.
Result & Outcome :
The program started on 1 November 2019 and results was collected up to 31 October 2020. 49 procedures fulfilled the inclusion criteria. Of which 10 patients failed the pre-anesthetic screening because of co-existing medical diseases or suboptimal social support. 39 patients succeeded to proceed as planned day procedure.
5 patients (12.8%) had unplanned overnight stay: 3 for wound observation, 1 for wound pain, and 1 for supplemental oxygen.
The median follow-up was 28 weeks. There was no unplanned return to the hospital. All patients had uneventful recovery without any wound complication.
The present quality improvement program showed that it is feasible to perform selected breast cancer surgery as day procedure. The program is on-going, and further analysis will be carried out to prove its cost-effectiveness and expand the service.
