The findings at the University of Rochester Medical Center and Wilmot Cancer Institute reflect a national trend toward reducing overnight hospital stays, when possible, after a major surgery such as removing all breast tissue to treat cancer.

However, the Rochester study is unique for focusing on older patients, given frailty issues that could make recovery at home riskier. (Frailty includes not only a weakened ability to get around, but also common medical conditions such as diabetes, heart problems, COPD, or recent pneumonia.)

Researchers screened patients for frailty, leveraging a renowned Wilmot program in geriatric oncology. They encouraged those who were moderate-to-highly frail to seek prehabilitation care, such as quitting smoking, getting better nutrition and exercise, and psychosocial support. The goal was to design a safe plan that could increase the rate of same-day discharges.

“We have an aging population that is living longer and healthier,” said Jessica Gooch, MD, associate professor of Surgery at URMC and a breast cancer specialist at Wilmot. She is first author on the study, which was recently published in Annals of Surgical Oncology.

Professional portrait of Jessica Gooch, MD
Jessica Gooch, MD
“It’s been a cultural shift to reconsider the way we do things. We’ve often discharged younger patients on the same day as surgery,” Gooch said. “In our study, it turns out that our quote-unquote elderly patients can do well at home, too. Many of them don’t actually seem that old. And if they have other medical issues that are well-managed and they have a good support system, they recover better in familiar surroundings. The overwhelming majority of the patients in our study were relieved or excited to go home.”

Historically, people who had a mastectomy would stay in the hospital for 48 hours with intravenous narcotics for pain. However, pain control methods have also changed in recent years, as a growing body of research at the UR and elsewhere shows that patients don’t always need narcotics after surgery.

Key findings from this small study of 55 patients:

During a 10-month period in 2023 when patients were screened for frailty, 32 of the 55 older patients (56 percent) went home on the same day as their surgery. This compares to 18 percent in 2022.
Average age of the women was 72 and some were much older, but researchers discovered that few were “frail,” as determined by a College of Surgeons professional index. Only seven people were referred to geriatric oncology or prehabilitation services prior to surgery.
More patients who stayed in the hospital overnight suffered from post-operative complications, such as blood clots or infections, compared to those who went home. Gooch noted that this counterintuitive finding may support the good judgment of doctors who chose to keep some patients in the hospital out of concern that they would develop complications.
This study and other quality-improvement research in the U.S. that challenges the status quo was born out of necessity during the COVID-19 pandemic, Gooch explained.

At that time, health systems and hospitals needed to find ways to provide safe care for all individuals, despite fewer resources and the need for more hospital beds for those severely infected with Covid. The result has been shorter hospitalizations when appropriate and more outpatient procedures.

The next step, Gooch said, is to report the patients’ feelings about recovering at home versus staying in the hospital after a mastectomy. To collect this information, the research team called the women during their first 24 to 72 hours at home after surgery. Preliminary results show no red flags.

“Age is just a number,” Gooch said. “It doesn’t have to be that once you reach an arbitrary defining line that says you’re old, that you have to stay in the hospital longer.”

The study not only reflects a growing trend but may serve the interests of Wilmot’s catchment area of 27 counties in western and central New York, where the population of older individuals is greater than state and national averages.

Source : https://www.urmc.rochester.edu/news/story/breast-cancer-surgery-is-an-overnight-hospital-stay-really-necessary