title: Initial experiences with a multidisciplinary approach to decreasing the length of hospital stay for patients undergoing unilateral mastectomy.
abstract: BACKGROUND
  We hypothesized that the introduction of a short-stay pathway would result in a significant reduction in length of stay for patients undergoing unilateral mastectomy, without a negative impact on patient safety.
  
  
  METHODS
  As part of a quality improvement project, a multidisciplinary committee designed a 1-day stay program for unilateral mastectomy patients. The study period was the first year after the 1-day pathway had routinely been implemented. We report on consecutive patients undergoing unilateral mastectomy ± tissue expander at Memorial Sloan-Kettering Cancer Center from July 1, 2009 to June 30, 2010. The primary endpoint was the percentage of patients discharged on postoperative day 1. Secondary endpoints included the incidence of postoperative complications within 30 days of surgery, reoperations, readmissions, and urgent-care visits within 7 days.
  
  
  RESULTS
  Over a 12-month period, 537 patients underwent unilateral mastectomy. Of those, 82.7% (444/537) were performed on a 1-day hospitalization basis, compared with 9.6% in 2008, before implementation of the 1-day plan. The 30-day complication rate was 6.1% (33/537). Overall, 2.6% of all patients had reoperation for hematoma (14/537), 0.9% had to be readmitted (5/537), and 1.5% (8/537) attended the urgent-care department. If all patients had stayed in the hospital for more than 1 day, none of the readmissions and only 2 urgent-care visits would have been prevented.
  
  
  CONCLUSIONS
  This study shows that a 1-day stay following mastectomy is easy to implement and safe for patients if a multidisciplinary team is involved in planning and implementation.
authors: Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors: W P
authors: WP
authors: Weber
authors: M
authors: M
authors: Barry
authors: M J
authors: MJ
authors: Junqueira
authors: S S
authors: SS
authors: Lee
authors: A M
authors: AM
authors: Mazzella
authors: L M
authors: LM
authors: Sclafani
mesh_terms: D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008408:Mastectomy; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D013997:Time Factors