Key message
Substantial variations exist, with a 38 percentage point difference between the provinces with the lowest and highest percentages of mastectomies performed as day surgery. However, the percentage of same-day mastectomy has increased over time in most provinces.
Indicator definition
The percentage of mastectomies for breast cancer tumour resection that were done as day surgery. The data include women with unilateral invasive breast cancer whose surgery occurred between April 2008 and March 2014 and are reported by province.
Measured since
The 2014 Cancer System Performance Report.
Why measure this?
Mastectomy is one of the standard curative treatments for women with resectable breast cancer. Although this procedure is relatively invasive, mastectomy can now be safely performed in an outpatient setting as same-day surgery.1 Outpatient mastectomy has been associated with high patient satisfaction and psychological well-being.2 In addition, shifting from inpatient to outpatient surgery for women undergoing mastectomy would yield a reduction in system costs and free up inpatient capacity. Measuring the percentage of mastectomies being performed as day surgery across provinces allows us to detect variations in practice, which could help identify opportunities for improving patient experience and reducing system costs by avoiding inpatient stays for patients who could safely recover at home.
What are the key findings?
- Between April 2009 and March 2014, between 1.4% (Alberta) and 39.3% (New Brunswick) of mastectomies were performed as day surgery (Figure 7.2).
- In eight of the nine reporting provinces, the percentage of mastectomies performed as day surgery increased from 2008/09–2010/11 to 2011/12–2013/14 (Figure 7.3)†.
- The percentage of day surgery for mastectomy increased from 29.6% in 2008/09–2010/11 to 46.9% in 2011/12–2013/14 in New Brunswick—the greatest increase among reporting provinces (Figure 7.3).
Why do these findings matter?
There was a 38 percentage point difference between the provinces with the lowest and highest reported use of mastectomies done as day surgery. Although both inpatient and outpatient mastectomies can be appropriate, same-day surgeries may have important implications for patient experience and resource use. Studies have shown that women who undergo mastectomy as day surgery likely have better physical and psychological recovery post surgery.2 This may be because many patients prefer to recover at home and benefit from the psychological boost of early discharge.3 Same-day surgery for breast cancer has also been linked to better satisfaction with care because of the perceived better continuity of care.4 There may also be a lower risk of exposure to hospital-acquired infection since the patient spends less time in the hospital. In addition, as long as similar or better patient outcomes are obtained, providing same-day surgeries could free up capacity for inpatient care.
It is important to note that not all mastectomies can be done as day surgery. The presence of comorbid conditions, post-surgical complications or lack of support for recovery at home may make mastectomies performed in an inpatient setting more appropriate for some patients.
Notes
† The period 2008–10 refers to April 2008 to March 2010. The period 2011–14 refers to April 2011 to March 2014.
References
- Downing A, Lansdown M, West R, Thomas J, Lawrence G, Forman D. Changes in and predictors of length of stay in hospital after surgery for breast cancer between 1997/98 and 2004/05 in two regions of England: a population-based study. BMC Health Serv Res. 2009;9(1):202.
- Marla S, Stallard S. Systematic review of day surgery for breast cancer. Int J Surg. 2009 Aug;7(4):318-23.
- Dawe DE, Bennett LR, Kearney A, Westera D. Emotional and informational needs of women experiencing outpatient surgery for breast cancer. Can Oncol Nurs J. 2014 Winter;24(1):20-30.
- Marsden J. Same day / 23 hour ambulatory surgery breast care model: is it feasible? [Internet]. King's College Hospital NHS; 2011 [cited 2015 Sept 21].
