National trends and outcomes of same-day discharge after direct-to-implant breast reconstruction: A 15-year NSQIP analysis.

Abstract

Same-day discharge following direct-to-implant (DTI) breast reconstruction is increasingly common; however, large-scale outcome studies are scarce. This study evaluated the trends and postoperative outcomes in patients who were discharged on the same day following DTI. We analyzed female patients with breast cancer who underwent DTI breast reconstruction from 2008-2023 using their data from the National Surgical Quality Improvement Program database. Patients were grouped by length of stay (LOS = 0 days (no overnight stay) vs. LOS > 0 days (with overnight stay)). Primary outcomes included 30-day surgical and medical complications, reoperations, and readmissions. Propensity score matching and inverse probability of treatment weighting were used to adjust for baseline differences between the 2 cohorts. Among 11,505 cases, 2457 (21.4%) patients were discharged the same day. Compared to inpatients, same-day discharge patients were on an average younger (mean age 51.2 vs. 53.4 years, p < 0.001) and had lower BMI (mean 26.9 vs. 28.1 kg/m², p < 0.001). After statistical adjustment for baseline patient differences, same-day discharge was associated with lower odds of any complication (OR 0.79, 95% CI 0.72-0.87, p < 0.001), reoperation (OR 0.72, 95% CI 0.63-0.82, p < 0.001), and readmission (OR 0.70, 95% CI 0.61-0.81, p < 0.001). There was no increase in surgical or medical complications in the same day discharge cohort. Same-day discharge after DTI breast reconstruction was safe, with no increase in short-term complications, among appropriately selected patients based on clinical and demographic factors. These findings support same day discharge after DTI in selected patients.