Abstract PO1-09-07: Outpatient mastectomy is a safe surgical option for patients treated in a rural Appalachian tertiary facility
Authors: Stimac Gregory , Lupinacci Kristin , Cowher Michael , Hazard-Jenkins Hannah 
Published: May 2024

Abstract
Background The feasibility of the outpatient mastectomy in a rural setting is poorly characterized. Centers treating rural patient populations have unique challenges. Limited access to resources and distance to facilities that can care for post-surgical patients are two such challenges. The aim of this study is to analyze the efficacy and safety of an outpatient mastectomy program in our tertiary care facility treating rural Appalachian patients. Methods We performed a single-institution retrospective review of all patients with breast cancer over 18 years of age who underwent a mastectomy with or without immediate alloplastic breast reconstruction at JW Ruby Memorial Hospital from 2019-2022. Our primary objective was to determine the 30, 60, and 90-day readmission rates. Our secondary objective included an analysis of perioperative pain control variables to develop an enhanced recovery protocol. Data collected included age, ethnicity, prognostic factors, stage at diagnosis, surgical treatment, opioid and non-opioid based treatments pre- and postoperatively by milligram morphine equivalents (MMEs), comorbidities as analyzed by the Charlson comorbidity index (CCI) variables, and distance from the tertiary hospital. Results We identified thirty-two women between 2019-2022 who underwent same-day mastectomy at JW Ruby Memorial Hospital in Morgantown, West Virginia. The mean age was 55.4 years. The mean distance to the hospital was 22.1 miles with a maximum distance of 111 miles (SEM = 3.90). The mean CCI score was 2.9 (SEM = 0.51). Overall readmission rates at 30- 60- and 90-days were 6.3% (n = 2), 3.1% (n = 1) and 0%, respectively. One woman was readmitted eight days postoperatively from a unilateral mastectomy and sentinel lymph node biopsy without reconstruction for an expanding hematoma of the chest after resuming anticoagulation on postoperative day three. The other two patients were admitted for unrelated surgical reasons. Thus, readmission related to surgical complications alone was 3.1% (n = 1). Preoperatively, 90.6% (n = 29) of women received a local anesthetic block by the anesthesia provider. Neither a preoperative nor intraoperative block was given to the remaining three. Bilateral mastectomies occurred in 21.9% (n = 7) of women and 78.1% (n = 25) underwent unilateral mastectomy. Of these 32 women, 25.0% (n = 8) underwent immediate staged reconstruction with tissue expanders. There were no direct-to-implant reconstructions in this population. There were twenty-six sentinel lymph node biopsies and four axillary dissections performed. The mean MMEs received for the duration of the hospital encounter was 132 (SEM = 23.4). An enhanced recovery after surgery protocol was not used. Discussion Outpatient mastectomy is a safe and effective option for eligible patients living in rural settings. Factors such as the type of mastectomy, reconstruction, the patient's overall health status, and the availability of support at home can impact the feasibility of this approach. Careful patient selection and a multidisciplinary team including the patient, surgeon, and anesthesiologist should carefully assess the individual’s circumstances to determine if outpatient mastectomy is appropriate. Implementation of enhanced recovery after surgery protocols will be further investigated and guided by this study.
Citation Format: Gregory Stimac, Kristin Lupinacci, Michael Cowher, Hannah Hazard-Jenkins. Outpatient mastectomy is a safe surgical option for patients treated in a rural Appalachian tertiary facility [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-09-07.