title: [Can we enhance the one-day part in breast conservative surgery?].
abstract: BACKGROUND
  French national guidelines lead us to increase the part of one-day breast cancer conservative surgery. Our objective was to check if we can enhance our outpatient part and to identify solutions to improve our practices.
  
  
  METHODS
  From 01/01/2013 to 31/12/2014, we conducted a monocentric and retrospective register about all cases of breast conservative surgery (infiltrating or in situ carcinoma, atypical hyperplasia). The collected data were: patients' sociodemographic characteristics, modality of hospitalization, surgical characteristics, preoperative exams organization, complications and reasons for an absence of surgery planned in one-day modality. We compared the two groups (one-day and standard hospitalization).
  
  
  RESULTS
  We reported 324 surgeries of which 50.3% planned in one-day mode. The outpatient part increased from 39.8% in 2013 to 60.8% in 2014. There was no difference for postoperative complications between the two groups. We found a higher rate of outpatient for sentinel node axillary dissection in 2014 (65% versus 37% in 2013). We reported a rate of axillary dissection in one-day mode of 20%, of which 15% were drained. The proportion of patients unplanned in one-day mode without contraindications was reduced from 81% in 2013 to 57% for 2014.
  
  
  CONCLUSIONS
  Increasing our outpatient part in breast conservative surgery was possible. There are still efforts to do to reach the national goals of one-day conservative breast cancer surgery, especially for the organizational aspects that remains the main obstruction. The implementation of pathways specifically for outpatient in and out of the hospital could be an interesting solution.
authors.affiliation: Université de Poitiers, faculté de médecine et de pharmacie, 86000 Poitiers, France; CHU de Poitiers, service de gynécologie obstétrique et médecine de la reproduction, 86000 Poitiers, France. Electronic address: bertrand.gachon@gmail.com.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Gachon
authors.affiliation: Université de Poitiers, faculté de médecine et de pharmacie, 86000 Poitiers, France; CHU de Poitiers, service de gynécologie obstétrique et médecine de la reproduction, 86000 Poitiers, France.
authors.forename: Cédric
authors.initials: C
authors.lastname: Nadeau
authors.affiliation: Université de Poitiers, faculté de médecine et de pharmacie, 86000 Poitiers, France; CHU de Poitiers, service de gynécologie obstétrique et médecine de la reproduction, 86000 Poitiers, France; CHU de Poitiers, centre d'investigation clinique plurithématique, Inserm CIC-P 1402, 86000 Poitiers, France; CESP UMR, Inserm U1018, équipe 7 : genre, santé sexuelle et reproductive, 94270 Le Kremlin-Bicêtre, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Fritel
mesh_terms: D000556:Ambulatory Surgical Procedures / Q000009:adverse effects / Q000706:statistics & numerical data* / Q000639:trends; D001365:Axilla; D001943:Breast Neoplasms / Q000601:surgery*; D002278:Carcinoma in Situ / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000601:surgery*; D005260:Female; D005602:France; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008197:Lymph Node Excision / Q000706:statistics & numerical data; D008207:Lymphatic Metastasis; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data* / Q000639:trends; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000706:statistics & numerical data
keywords: Axillary dissection; Breast cancer; Breast conservative surgery; Cancer du sein; Chirurgie ambulatoire; Chirurgie conservatrice du sein; Curage axillaire; One-day surgery