Comparing Discharge Timing in Patients Undergoing Immediate Implant-Based Breast Reconstruction: A Randomized Controlled Trial.

Abstract

Implementation of Enhanced Recovery After Surgery (ERAS) programs have shown that same day discharge of patients undergoing immediate implant-based reconstruction following mastectomy is safe. The purpose of this study was to compare outcomes of patients in ERAS programs undergoing mastectomy with immediate implant-based breast reconstruction discharged on the day of the surgery (POD0) versus post-operative day one (POD1). A randomized controlled trial was conducted on patients who underwent immediate implant-based breast reconstruction after mastectomy. Patients were randomized to discharge either POD0 or POD1. All patients completed perioperative patient-reported outcome (PRO) surveys and recorded post-operative opioid consumption (converted to morphine milligram equivalents, MME). Thirty-day post-operative outcomes and complications were recorded. A total of 217 breasts were reconstructed in 121 patients, with mean age of 48 years. The most frequent complication was seroma (4.8%), followed by mastectomy flap necrosis (2.4%). There were no significant differences in 30-day complications between the two cohorts. Ten patients presented to the emergency room within 30 days of discharge (POD0=6 vs POD1=4) (p=0.52), with 4 patients requiring hospital admission. Six patients (5%) required reoperation (POD0=4 vs POD1=2) (p=0.99). There was no difference in post-operative pain scores, post-operative MME consumption, or in PRO scores. Regardless of whether mastectomy patients undergoing immediate implant-based breast reconstruction are discharged on POD0 or POD1, complication rates are similarly low with no difference in PROs or opioid consumption. ERAS pathways may be useful in optimizing patient care to allow for same day discharge while maintaining high-quality of care.