A comprehensive meta-analysis and systematic review of same-day discharge protocols following mastectomy with immediate breast reconstruction in surgical oncology

Resumo

Objective: This meta-analysis and systematic review aimed to update the evidence on the safety, feasibility, and outcomes of same-day discharge (SDD) after mastectomy with immediate breast reconstruction. Factors influencing SDD
were identified by reviewing variables such as age, comorbidities, reconstruction type, and intraoperative and postoperative management. Key outcomes compared SDD and overnight hospitalization, including analysis on complication
rates, readmissions, pain control, and patient satisfaction. This study sought to provide evidence on the effectiveness of
SDD protocols and their impact on clinical practice, assessing whether SDD can offer a safe, effective alternative to traditional hospitalization for selected patients. Methods: The analysis of 61,537 patients across eight studies concluded that
SDD after mastectomy with immediate reconstruction did not increase complication, readmission, or reoperation rates.
The meta-analysis revealed a moderate and statistically significant effect favoring SDD, with an effect size of 0.193 (95%
confidence interval [CI] 0.034–0.352; p=0.017). The I2
statistic of 0% indicated no heterogeneity, reinforcing the robustness
of the results. No publication bias was detected. Results: Traditionally, patients remain hospitalized for postoperative
monitoring, but advancements in anesthesia and surgery have made SDD an increasingly viable option. Studies suggest
that SDD is safe and effective, with no significant increase in complications, readmissions, or reoperations compared to
overnight stays. Patient selection is crucial, with factors such as comorbidities and reconstruction type influencing outcomes. Proper pain management and follow-up care are essential for success. Standardizing protocols for SDD could help
minimize variability in outcomes and ensure consistent patient care. Conclusion: The findings of this review suggest that
SDD after mastectomy with immediate breast reconstruction is a safe, feasible, and advantageous strategy for selected
patients. The implementation of this protocol can optimize hospital resources without compromising patient safety and
clinical outcomes. It is possible to anticipate that this approach is a reality.