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Clinical Trial Details — Status: Not yet recruiting

Administrative data

NCT number NCT02791672
Other study ID # 20160216-01H
Secondary ID
Status Not yet recruiting
Phase N/A
First received May 31, 2016
Last updated June 2, 2016
Start date June 2016
Est. completion date June 2017

Study information

Verified date May 2016
Source Ottawa Hospital Research Institute
Contact Michael J Stein, MD
Phone 6132864646
Email micstein@toh.on.ca
Is FDA regulated No
Health authority Canada: Canadian Institutes of Health Research
Study type Observational

Clinical Trial Summary

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.


Description:

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.


Recruitment information / eligibility

Status Not yet recruiting
Enrollment 40
Est. completion date June 2017
Est. primary completion date June 2017
Accepts healthy volunteers No
Gender Female
Age group 18 Years and older
Eligibility Inclusion Criteria:

- All patients who undergo breast reconstruction using the latissimus dorsi myocutaneous flap.

Exclusion Criteria:

- All patients undergoing breast reconstruction without the latissimus dorsi flap.

Study Design

Observational Model: Cohort, Time Perspective: Prospective


Related Conditions & MeSH terms


Intervention

Behavioral:
Discharge within 24 hours
If both the physician and patient have no concerns within 24 hours of a Latissimus Dorsi Flap breast reconstruction the patient will be discharged home and enrolled in the cohort group.

Locations

Country Name City State
n/a

Sponsors (1)

Lead Sponsor Collaborator
Ottawa Hospital Research Institute

Outcome

Type Measure Description Time frame Safety issue
Primary Conversion rate (from same-day discharge to in-patient care) 24 hours No
Primary Patient Satisfaction using Breast-Q questionnaire and Perioperative Care Patient 24 hours No
Primary Pain Score 24 hours No
Primary Amount of post-operative (24 hours) narcotic usage 24 hours No
Secondary Short and Long term complications 24 Hours No
Secondary Readmission Rate 24 Hours No
Secondary Cost Savings 24 Hours No
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