Major Ambulatory Surgery for the Treatment of Breast Cancer: Factors Conditioning Conversion to Conventional Hospitalization

Raúl Medina Velázquez, Laura Jiménez Díaz, Jezabel Fernández Carrión, Clara Rosas Bermúdez, Montserrat Miralles Curto, María Asunción Acosta Mérida, Joaquín Marchena Gómez.

Cirugía Española (English Edition), Volume 97, Issue 1, janvier 2019.

Abstract: Introduction

The main step in curative treatment for breast cancer is surgery. Its use in an ambulatory setting can contribute toward more efficient healthcare, providing additional benefits for patients. In this study, we analyze the results obtained with this treatment method and identify factors related with conversion to hospitalization.

Methods

Results were analyzed from the 206 surgeries performed for breast cancer in 2016, using three different methods: day surgery, overnight ambulatory (23h) and conventional hospitalization. The ambulatory success and conversion rates were calculated for the global sample and stratified, distinguishing between conservative surgery, mastectomy and axillary surgery. A univariate analysis was performed to identify the factors involved in conversion.

Results

For the global sample, the ambulatory surgery rate was 61.2%, 16.5% conversions and a success rate of 83.4%. For conservative surgery, ambulatory, success and conversion rates were 78.8%, 88.6 and 11.4%, respectively. For mastectomies, the ambulatory rate was 28.6%, with 62.9% success and 37.1% conversions. The 11 axillary surgeries were performed as day surgeries. Factors associated with conversion were mastectomy versus conservative surgery and the appearance of postoperative complications.

Conclusions

Ambulatory surgery for the surgical treatment of breast cancer should be standard care. Optimized results require adequate patient selection and the performance of surgical technique that needs to be as careful and as conservative as possible.