Abstract P2-13-08: Initial experience with an ambulatory extended recovery program for patients undergoing mastectomy
Authors: Manning Aidan T , Cassella Danielle , Ugras Stacy , Tseng-Reyes Beverly , Sclafani Lisa 
Published: May 2015

Abstract
Introduction: An ambulatory surgical program has been introduced at Memorial Sloan Kettering Cancer Center for patients undergoing select procedures that require a single overnight stay. The aim of this study was to review the initial experience with this program for patients undergoing mastectomy and to determine the rate and cause of unanticipated hospital admission.
Methods: All patients undergoing mastectomy with or without implant based reconstruction from March 2013 to February 2014 inclusive were entered into the Ambulatory Extended Recovery (AXR) program and data were recorded in a prospectively maintained AXR database. Data on patient demographics, type of procedure performed, and whether the patient remained on the AXR program were extracted. Electronic Medical Records were reviewed for all patients who required hospital admission in order to determine the reasons for this.
Results: 926 consecutive patients (905 female, 21 male) requiring mastectomy with or without implant based reconstruction were entered into the AXR program during this one-year period (mean age was 51 years, range 21-90). The procedures performed were as follows: bilateral mastectomy with reconstruction (n=433, 46.8%); bilateral mastectomy without reconstruction (n=48, 5.2%); unilateral mastectomy with reconstruction (n=255, 27.5%); and unilateral mastectomy without reconstruction (n=190,20.5%), with or without axillary procedures. Reconstructive procedures deemed suitable for the AXR program included tissue expander or permanent implant insertion only. 861 of 926 patients (93%) remained on the AXR program and were discharged following overnight stay. 62 patients (6.7%) (61 female, 1 male) did not complete the AXR program and required hospital admission (mean age, 52 years; range, 22-81). 3 additional patients (0.3%) required hospital admission on occasions that the AXR unit was at maximum capacity. Reasons for admission are shown in Table 1. Of the 26 patients with postoperative hematoma, 17 were brought back to the Operating Room for definitive management and 9 patients were treated conservatively. Following admission, most patients (52 of 62, 83.9%) were fit for discharge after 1 day. Of the remaining 10 patients, 9 were discharged after 2 days and 1 after 5 days.
Reason for hospital admission for 62 of 926 patients scheduled for breast surgery on the Ambulatory Extended Recovery (AXR) programReason for AdmissionHematoma26Pain control17Nausea5Urinary Retention4Cardiac Issues5Other (respiratory issue, poor mobility, social admission, fall on ward, pyrexia)5Total62
Conclusion: Unilateral and bilateral mastectomy, with or without implant based reconstruction, is safely performed in the setting of an AXR program. Only a small minority of patients will subsequently require hospital admission, most commonly for management of postoperative hematoma or inadequate pain control.
Citation Format: Aidan T Manning, Danielle Cassella, Stacy Ugras, Beverly Tseng-Reyes, Lisa Sclafani. Initial experience with an ambulatory extended recovery program for patients undergoing mastectomy [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-13-08.