Mammaplasty Clinical Trial
Official title:
Perioperative Care of Breast Reconstruction With Latissimus Dorsi Flap and Tissue Expander: Early Discharge Protocol in a Day Surgery Setting
The pedicled latissimus dorsi flap is a piece of tissue taken from the back that is used to
reconstruct the breast after cancerous tissue is removed. Over the years, improvements in
surgical technique and pain control have decreased the length of stay in hospital after this
procedure. Recently, early discharge after breast reconstruction using another very similar
pedicled flap, called the transverse rectus abdominis flap, was shown to be safe,
patient-centered, and associated with significant hospital cost-savings by another Canadian
group.
With increasing pressure from hospital administrators to weigh financial considerations into
treatment decision making, doctors must test cost-saving strategies in order to ensure
patient satisfaction and safety. Here, we plan to evaluate patient safety, satisfaction and
cost efficacy in breast reconstruction using the pedicled latissimus dorsi myocutaneous
flap.
We hypothesize that patient care planning can allow for safe and cost-effective same-day
discharge and improved patient satisfaction after autologous breast reconstruction using the
pedicled latissimus dorsi flap. After nearly 10 successful same-day discharges using this
flap, our experience at the Ottawa Hospital suggests that this practice is safe, has
increased patient satisfaction scores, decreased narcotic use, no short or long term
complications and is more cost effective compared to patients who stay overnight.
In the present study, we hope to quantify our results by demonstrating that same day
discharge is a cost effective strategy that does not compromise patient safety and
satisfaction.
The pedicled latissimus dorsi myocutaneous flap is a reliable option for autologous breast
reconstruction after mastectomy. Improvements in technique and postoperative analgesia have
decreased the length of hospital stay required after this procedure. Early discharge
following a range of procedures has been consistently shown to increase patient
satisfaction, decrease perioperative complication rates, and improve hospital
cost-effectiveness. Specifically, early discharge after breast reconstruction using another
pedicled myocutaneous flap, the transverse rectus abdominis myocutaneous flap, was shown to
be safe, patient-centered, and associated with significant hospital cost-savings by another
Canadian group.
The balance between financial savings and patient safety/comfort has been studied vigorously
across many medical disciplines. With increasing pressure from hospital administrators to
weigh financial considerations into treatment decision making, clinicians must empirically
test cost-saving strategies in order to ensure patient satisfaction and safety.
Here, we evaluate patient safety, satisfaction and cost efficacy in ambulatory breast
reconstruction using the pedicled latissimus dorsi myocutaneous flap.
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