TIP37 Evaluating Barriers to Home Recovery After Mastectomy at a Single Hospital System

Background

There has been a shift in recent years toward home recovery after mastectomy (HRAM). This paradigm change has evolved from efforts toward quality improvement for patients with breast surgery in the postoperative setting. Specifically, this includes methods to decrease inpatient resource depletion, decrease health care costs associated with a hospital stay, and reduce patient exposure to postoperative opioid use, which may be more prevalent during recovery in the hospital than at home. Furthermore, hospital pathogen exposure to disease processes such as COVID-19, influenza, and respiratory syncytial virus and from Clostridioides difficile is minimized by outpatient surgery. Patients who are well equipped—mentally, physically, and supply wise—should be able to safely recover at home following uncomplicated mastectomy. Although an Enhanced Recovery After Surgery (ERAS) model was initiated years ago in our hospital system, many patients still decline the option to go home for their recovery. Around the time of ERAS implementation, a prior survey was distributed and demonstrated that pain control did not seem to be a major limitation, which begs the question: What is still felt to be a restricting factor? In this study, we aim to explore the patient’s perception of home recovery, namely in terms of perceived barriers, need for additional resources to safely transition home, and reflections on the recovery experience as a whole. Our overarching goal is to determine why patients are not choosing HRAM even when objectively able.

Materials and Methods

Project approval was received from the Quality Improvement Review Committee. Surveys (Figure) were printed on paper and distributed at postoperative appointments for all patients with mastectomy, including simple, skin sparing, and nipple sparing patients, as well as those with immediate tissue expander or implant reconstruction. Patients who had autologous flap reconstruction were excluded. Other excluded patients were up to the discretion of the surgeon, including those with significant medical comorbidities that required overnight monitoring or patients with any concern for flap compromise during the procedure. In order to maintain patient anonymity, the survey did not include any identifying information. They were collected before the patient left the clinic.

Status

Surveys have been continuously collected in the office for the past 2 and a half months, with an end goal of 3 months of survey collection. The results will then be cataloged and evaluated, and we anticipate full analysis to be completed in the next 2 months. The data collected from survey review will be used in the future to create a pathway to more specifically determine which patients in our hospital system would benefit from the same-day mastectomy vs inpatient recovery.