title: Same-Day Major Breast Cancer Surgery is Safe: An Analysis of Short-Term Outcomes Using NSQIP Data.
abstract: Most patients undergoing significant breast cancer surgery stay in hospital postoperatively. We sought to determine whether there was a difference in complication rates among patients undergoing same-day surgery (SDS) versus overnight or inpatient stay.
  
  
  
  Analysis of the American College of Surgeons, National Surgical Quality Improvement Program participant user files was performed. Patients with breast cancer undergoing mastectomy and/or axillary lymph node dissection between 2005 and 2012 were examined (high-risk comorbidities and concurrent surgery were excluded). Thirty-day postoperative morbidity was analyzed. Multivariable regression was performed identifying independent predictors of complications.
  
  
  
  The final population consisted of 40,575 patients; 8365 had SDS, 23,252 stayed overnight, and 8958 stayed in hospital longer postoperatively. Those admitted to hospital were older, more obese, had higher American Society of Anesthesiology (ASA) class, medical comorbidities, or had bilateral surgery. The overall 30-day morbidity was 4.7 %. On univariate analysis, patients undergoing SDS had significantly lower 30-day morbidity (2.4 %) compared with overnight (3.9 %) or inpatient stay (8.8 %) (p < 0.0001). After controlling for the above differences between groups, patients staying overnight had a higher odds of postoperative complications [1.37, 95 % confidence interval (CI) 1.16-1.63, p = 0.004] and inpatients had over twice the odds of postoperative complications (2.65, 95 % CI 2.21-3.18, p < 0.0001) compared with SDS patients.
  
  
  
  This is the largest study examining the safety of SDS for breast cancer. Complication rates were significantly higher for patients admitted to hospital postoperatively, even after controlling for baseline differences. These data suggest that, with appropriate selection, it is safe to perform major breast cancer surgery on a same-day basis.
authors.affiliation: Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada. ecordeiro@toh.on.ca.
authors.forename: Erin
authors.initials: E
authors.lastname: Cordeiro
authors.affiliation: Department of Surgery, University of Toronto, Toronto, ON, Canada.|Division of General Surgery, University Health Network, Toronto, ON, Canada.
authors.forename: Timothy
authors.initials: T
authors.lastname: Jackson
authors.affiliation: Department of Surgery, University of Toronto, Toronto, ON, Canada.|Division of General Surgery, University Health Network, Toronto, ON, Canada.|Department of Surgery, Women's College Hospital, Toronto, ON, Canada.
authors.forename: Tulin
authors.initials: T
authors.lastname: Cil
mesh_terms: D000556:Ambulatory Surgical Procedures; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008197:Lymph Node Excision; D008408:Mastectomy; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors