Breakthrough study by Kaiser Permanente supports outpatient breast cancer surgery
A year ago when her surgeon asked if she wanted to go home a few hours after her right breast was removed, Santa Rosa hairdresser Wendy Woods jumped at the chance.
Woods, 64, a stylist at Icon Hair Salon on Fourth Street, felt fine after a mastectomy in November to treat her breast cancer and saw no need to stay overnight at the hospital. Recently, a salon client facing a similar operation asked her if she’d recommend going home the same day as surgery.
“I told her if you don’t have to stay, don’t,” Woods said. “You’ll be more comfortable at home. I slept all night that first night.”
Woods is among a growing number of breast cancer patients being discharged from the hospital on the same day they have surgery. New home-based recovery programs are increasingly replacing post-surgery hospital stays of one or two days.
After passage of the Women’s Health and Cancer Rights Act of 1998 — which required health insurers to pay for reconstructive surgery for mastectomy patients — it became “progressive” medical practice to let women stay in the hospital two days after certain mastectomy procedures, said Dr. Elizabeth Peralta, a breast surgeon for Sutter Medical Group of the Redwoods.
But in recent years with less-invasive procedures and an increase in the use of nonnarcotic pain and inflammation medication, hospital stays after breast surgery have been greatly reduced to less than 24 hours, Peralta said.
Recently, a medical study across 21 Kaiser Permanente sites in Northern California — including Kaiser Permanente Santa Rosa Medical Center — showed results that reinforced sending mastectomy patients home just hours after surgery.
The study, published this month in the Annals of Surgical Oncology, is the first large evaluation in the nation of a hospital systemwide at-home recovery program for mastectomy patients.
The research documented a dramatic increase in the rate of outpatient breast surgeries across Kaiser medical centers with no significant increase in post-surgery patient issues requiring emergency room visits or hospital readmissions.
“When the patients wake up, they’re surprised they had surgery,” said Dr. Lucinda Romero, one of the authors of the study and a surgeon at Kaiser’s Santa Rosa medical center.
Romero, who primarily performs breast and vascular surgery, said for years she’s been sending patients home the same day as their operations. Romero and other Kaiser physicians helped develop a medical protocol for recovery at home that involved input of surgeons, specialized nurses for breast care and anesthesiologists.
The study period was from 2017 to 2018 and involved 84 surgeons performing 1,380 breast surgeries.
In 2017, only 23% of the 717 mastectomies performed by Kaiser surgeons were outpatient surgeries. A year later, the number of outpatient procedures increased to 61%, or 663 mastectomies, according to the study.
The average length of stay at a Kaiser hospital over the two years was nearly cut in half, from an average of 22.9 hours to 12.6 hours.
Kaiser’s outpatient breast surgery involves setting clear patient expectations for home recovery; teaching patients how to manage pain levels at home with minimal use of opioids; early collaboration with plastic surgeons for reconstructive surgery patients; and regular follow-up with patients after discharge.
Lisa Mindemann, a Kaiser breast care nurse, said the outpatient option for breast surgery patients begins with patient education. Mindemann sees a patient right after the woman gets a test result indicating cancer. She lays out the entire medical journey, including treatment options and potential doctors involved.