Abstract P5-16-09: Same-day surgery impact on breast reconstruction program in a public healthcare system: An affordable booster
Authors: Bargalló-Rocha JE , Gutiérrez-Zacarías LM , Maciel-Miranda A , Figueroa-Padilla J , Drucker-Zertuche M , Esparza-Arias N , Elizalde-Méndez A , Cabrera-Galeana PA 
Published: May 2019

Abstract
Background
Breast cancer represents the most common malignancy in Latin America, and since 2006 it is the cancer type with the highest incidence among Mexican women. Providing multidisciplinary high-quality care for the growing population of patients with breast cancer represents a challenge to low and middle-income countries, which have limited economic resources and limited health staff and facilities.
Since 2007, Seguro Popular insurance program has provided coverage for the treatment of women with breast cancer, including surgery, radiotherapy, chemotherapy, endocrine therapy and Her2-targeted treatments; before this program up to 50% of the Mexican population did not have healthcare coverage, and had to pay out of pocket for cancer care. Unfortunately, due to financial constraints, this does not include other interventions which may be relevant, such as supportive care and reconstructive surgery.
National Cancer Institute of Mexico (INCan) is a part of the Mexican federal government and as such provides care to uninsured individuals with all types of malignancies, including breast cancer. Since the start of Seguro Popular insurance program (2007), INCan has provided oncological care to over 5,000 women with breast cancer.
In 2012, INCan received a grant from the federal government (P017 Reproductive Health and Gender Equality in Health Grant) in order to establish the “Post-Mastectomy Program” (PMP), which aimed providing free patient navigation, supportive care and breast reconstruction for women after mastectomy. Starting on july 2016, derived from PMP, it was possible the setting of a Same-Day Surgery Facility (SDSF) at INCan: two small, fully equipped operation rooms with a small recovery area; and the hiring of 4 nurses and 2 anesthesiologists, adding all this to the one main operation room already set for breast cancer surgery. This allowed an increase in all kind of breast cancer surgery: conservative surgery, mastectomy with sentinel lymph node and breast reconstruction procedures. One of this rooms was assigned to breast reconstructive surgeries.
Material and Methods
Data were retrospectively collected from a 5 year period, 30 months before SDSF and 30 months after SDSF. Before SDSF an average 66.4 (54-73) of breast reconstruction surgeries were done by six month period, total of 332 breast reconstruction surgeries. After implementation of SDSF an average of 124 (107-138) by six month period, with a total 621 surgeries, which represents an 87% increase in breast reconstruction procedures for the same time period.
Conclusion
Same day surgery has been proven before to be safe in breast cancer surgery and in breast reconstructive surgery when co-morbidities are accounted for.
This work shows that implementation of Same-Day Surgery could be a tool to increase the offer of breast reconstruction in economically restrained systems, in early or experienced breast reconstruction programs in developing economies, and even in developed ones.
In our experience, this approach achieved an 87% increase in breast reconstruction procedures, in a 30 month period, which allowed us to benefit more women and offer them a better quality of life.
Citation Format: Bargalló-Rocha JE, Gutiérrez-Zacarías LM, Maciel-Miranda A, Figueroa-Padilla J, Drucker-Zertuche M, Esparza-Arias N, Elizalde-Méndez A, Cabrera-Galeana PA. Same-day surgery impact on breast reconstruction program in a public healthcare system: An affordable booster [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-16-09.