title: Is discharge home with drains after breast surgery producing satisfactory outcomes?
abstract: OBJECTIVE
  To assess whether discharging patients after breast cancer surgery with drains in situ and specialist nurse support is producing satisfactory outcomes.
  
  
  METHODS
  A retrospective study assessing outcome subjectively and objectively in patients treated at the Breast Unit. The full population of patients (124) operated for breast cancer and discharged with drains in situ, comprising 84 mastectomies and 40 wide local excisions with axillary clearance (WLE). Patients were asked to complete a postal questionnaire, and complication and activity data were analysed.
  
  
  RESULTS
  The questionnaire response rate was 60%. Only 10% of patients felt the care received at home was 'worse' than that received in hospital. Over a quarter of locally-conservative surgery patients described not being informed of the plan to discharge them with a drain in situ compared to only 9% of mastectomy patients. Only 6% of patients felt 'confident' going home early from hospital. On their first day at home, two-thirds of patients admitted feeling anxious and this was halved by the second day. Lack of confidence emptying drains was significantly worse in older patients. Complication rates were low and mean bed-days saved per patient was 4.7 days (SD 2.3).
  
  
  CONCLUSIONS
  Overall patient satisfaction, hospital bed-days saved and low complication rates showed the efficacy of this early discharge policy. There were specific areas needing improvement. Patients should be more clearly informed of the early discharge plan. Greater attention should be paid to allaying patient anxiety during the first day at home, especially in older patients.
authors.affiliation: Department of Breast and Endocrine Surgery, Northwick Park Hospital, Harrow, Middlesex, UK. michael.burke@nwlh.nhs.uk
authors.forename: Neil K
authors.initials: NK
authors.lastname: Chadha
authors.forename: Sandra
authors.initials: S
authors.lastname: Cumming
authors.forename: Ruth
authors.initials: R
authors.lastname: O'Connor
authors.forename: Michael
authors.initials: M
authors.lastname: Burke
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000209:etiology; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000601:surgery*; D004322:Drainage / Q000379:methods* / Q000592:standards; D005260:Female; D006699:Home Care Services / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008408:Mastectomy / Q000379:methods*; D008875:Middle Aged; D010351:Patient Discharge; D010353:Patient Education as Topic / Q000592:standards; D017060:Patient Satisfaction; D011182:Postoperative Care / Q000379:methods / Q000592:standards; D012189:Retrospective Studies; D012648:Self Care; D016896:Treatment Outcome