Physicians and surgeons take the blame for complications resulting from early discharge after a mastectomy, patients take the risks, and HMOs pocket the profits. Until a year ago, the standard of care for a mastectomy was that the length of the hospital stay was based on the patient's age, family situation, support system, tolerance of pain, how comfortable the patient is with drains, and other comorbid conditions. No studies show it's safe for a woman to go right home or, even if she can, that her needs for pain control, drain management, and emotional support can be met there.
Mastectomy is painful.
Women who undergo a mastectomy have two rubber drains that usually need to stay in for 48 hours. Most said they'd be afraid to empty the drains and worried about infection. I can tell a woman there is no increased risk of infection, but her perception is her reality. HMOs say that physicians have the final word. When I challenged the denial of hospitalization for one of my patients, the HMO's medical director said outpatient surgery was the standard of care in Connecticut for mastectomies and that the patient could have her pain controlled with pills.