title: Fast-track surgery for breast cancer is possible.
abstract: BACKGROUND
  Breast cancer is common among Danish women with more than 4,100 new cases annually. In 2008 the concept of fast-track surgery was introduced at the Department of Breast Surgery at Rigshospitalet, Copenhagen. The aim of this study is to describe the new clinical pathway for breast cancer patients after implementation of a fast-track surgery programme.
  
  
  METHODS
  A clinical pathway of all involved disciplines was developed including anaesthetic, analgesics, nausea and vomiting, drain and wound management, discharge assessment and psychosocial support.
  
  
  RESULTS
  The overall mean length of stay (LOS) decreased from 3.6 days before introduction of fast-track surgery to 1.2 days after its implementation. The largest decrease was observed among patients undergoing mastectomy, where LOS was reduced from 5.0 to 1.6 days. The number of beds at the department was reduced by about 30% and a nurse-led clinic was established which enabled nurses to take charge of wound management, seromas, temporary breast prostheses and psychosocial and rehabilitation aspects in the outpatient clinic. Additionally, the previously available telephone counselling service was intensified to provide immediate advice and support.
  
  
  CONCLUSIONS
  The results confirm that a short stay can be successfully carried out for breast cancer patients. Implementing the fast-track programme involved the introduction of a clear clinical pathway for the patients and more effective daily routines. Patients felt safe and confident after early discharge.
  
  
  BACKGROUND
  not relevant.
  
  
  BACKGROUND
  not relevant.
authors.affiliation: Sektion for Brystkirurgi, Rigshospitalet, 2100 Copenhagen Ø, Denmark. birgitte.goldschmidt.mertz@rh.regionh.dk
authors.forename: Birgitte G
authors.initials: BG
authors.lastname: Mertz
authors.forename: Niels
authors.initials: N
authors.lastname: Kroman
authors.forename: Helene
authors.initials: H
authors.lastname: Williams
authors.forename: Henrik
authors.initials: H
authors.lastname: Kehlet
mesh_terms: D000771:Anesthesia, Intravenous; D001943:Breast Neoplasms / Q000601:surgery*; D019091:Critical Pathways; D004322:Drainage; D005260:Female; D015277:Hotlines; D006801:Humans; D007902:Length of Stay; D008408:Mastectomy; D010149:Postoperative Pain / Q000188:drug therapy; D010348:Patient Care Team; D011182:Postoperative Care / Q000379:methods*; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control; D057184:Practice Patterns, Nurses'; D012944:Social Support