Safety and feasibility of early postmastectomy discharge and home drain care in a low resource setting

Olalekan Olasehinde Olusegun Alatise , Olukayode Arowolo, Adewale Adisa, Funmilola Wuraola, Carla Boutin-Foster, Oladejo Lawal, Thomas Kingham


Abstract

Background: Early postmastectomy discharge with a drain in place is standard practice in most developed countries. Its feasibility has not been evaluated in low resource settings like Nigeria.

Methods: Consenting patients undergoing mastectomy were discharged on the third postoperative day and assessed as outpatients for wound complications as well as their experience at home. Wound outcomes were compared with patients who had traditional long stay.

Results: Forty-five of the 58 patients who had a mastectomy during the study period participated in the early discharge program (77.6%). Of these, four patients (8.9%) had drain malfunction, seroma occurred in eight patients (17.8%), eight patients (17.8%) had wound infection, and six patients (13.3%) had flap necrosis. There was no readmission. Compared with long stay patients, postoperative stay was significantly shorter (3 vs 11 days; P < 0.01) with significant cost savings, while complication rates were not statistically different. All the patients in the early discharge group were confident operating their drains and preferred early discharge. Being around relatives, reduced cost, and fear of the hospital environment were common reasons cited for their preference.

Conclusion: Our results support the implementation of an early postmastectomy discharge program in a low resource setting.

Keywords: breast; mastectomy; seroma.

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