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Impact of Transitioning to Same Day Discharge Following Immediate Prosthetic Breast Reconstruction during the COVID-19 Pandemic
Samuel M. Manstein, Elizabeth Laikhter, Eric Shiah, Carly D. Comer, Samuel J. Lin
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA

Background: Following the reopening of elective surgery, our division transitioned from inpatient admission to same-day discharge for immediate prosthetic reconstruction patients in an effort to decrease the hospitalís clinical burden and minimize potential infection exposure. In order to analyze outcomes after this acute transition, this study aims to compare complication rates for patients who had inpatient and outpatient mastectomy with alloplastic reconstruction to determine whether same-day discharge for these patients is safe and feasible during the COVID-19 pandemic and beyond. Methods: A chart review was performed on patients who underwent mastectomy with immediate prosthetic reconstruction with either tissue expander or breast implants from 2018 to 2020. Data was collected on demographics, timing of surgery regarding the COVID-19 pandemic, BMI, comorbidities, substance use, anticoagulation, outpatient vs. inpatient surgery, length of stay, TNM staging, neoadjuvant treatment, and surgical details. The outcome of interest was 30-day morbidity, which was stratified into major and minor complications. Descriptive statistics of baseline characteristics for patients who underwent mastectomy with alloplastic reconstruction were compared for patients with outpatient and inpatient surgeries. Odds ratios were calculated using univariate binomial regression to determine whether any pre-operative factors increased odds of 30-day complications. Result:s A total of 115 patients were included in this study. Twenty-six patients had outpatient surgery and 89 stayed inpatient postoperatively. Sixteen patients stayed inpatient after the reopening of elective surgery. Same-day discharge did not significantly impact the odds of having one or more complications (OR 0.353, 95% CI: 0.097 - 1.285, p = 0.114). Factors that increased odds of complications for all patients were age (OR: 1.077, 95% CI: 1.034 - 1.121, p < 0.001), BMI (OR: 1.128, 95% CI: 1.046 - 1.217, p = 0.002), hypertension (OR: 6.500, 95% CI: 2.429 - 17.395, p < 0.001), and diabetes mellitus (OR: 10.875, 95% CI: 1.082 - 109.324, p = 0.043). Following the reopening of elective surgeries, a greater proportion of patients who stayed inpatient had liver disease (0% vs 18.75%, p = 0.027) and a greater proportion had to return to the operating room within 30 days of the primary surgery (0% vs 18.75%, p = 0.027). Conclusion:s Transitioning from inpatient to outpatient surgery for mastectomy with immediate prosthetic reconstruction did not significantly impact 30-day complication rates. A benefit in current practice is a potential decrease in COVID-19 exposure. Our findings support a continuation of same-day discharge strategy which could decrease costs for patients and hospitals.


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