Our Summary

The research paper analyzes the value of outpatient (ambulatory) Modified Radical Mastectomy (MRM), a type of breast cancer surgery. The researchers used state databases from 2016 to examine surgical outcomes and costs for 8,090 patients who underwent MRM, with 63% of these surgeries performed in a hospital and 37% performed as outpatient procedures.

The study found that patients who underwent outpatient MRM were typically older, more often white, had lower incomes, were insured by Medicare, and lived in smaller metro areas. Interestingly, fewer outpatient patients were readmitted to the hospital within 30 days due to surgical complications than those who had the surgery in a hospital.

Additionally, the cost of outpatient MRM was significantly less than inpatient MRM, even after adjusting for the length of hospital stay. This difference remained significant even when a patient had to be readmitted to the hospital.

In conclusion, the research suggests that outpatient MRM is both safer and less expensive than inpatient MRM. This could mean that MRM, which has been traditionally performed in a hospital setting, could be safely and more cost-effectively transitioned to an outpatient setting for suitable patients.

FAQs

  1. What is the difference in cost between outpatient and inpatient Modified Radical Mastectomy (MRM)?
  2. What demographics were more likely to undergo outpatient MRM according to the study?
  3. Does the study suggest that outpatient MRM procedures result in fewer hospital readmissions compared to inpatient MRM procedures?

Doctor’s Tip

A doctor might tell a patient considering a radical mastectomy that outpatient (ambulatory) surgery is a safe and cost-effective option. This type of surgery has been shown to have lower rates of readmission due to complications and is significantly less expensive than inpatient surgery. Patients who are older, insured by Medicare, and living in smaller metro areas may be good candidates for outpatient MRM. It is important to discuss with your healthcare provider to determine if outpatient MRM is the right choice for you.

Suitable For

Patients who are suitable for outpatient Modified Radical Mastectomy (MRM) are typically older, more often white, have lower incomes, are insured by Medicare, and live in smaller metro areas. These patients are less likely to experience surgical complications that require readmission to the hospital within 30 days. Overall, outpatient MRM is found to be a safe and cost-effective alternative to inpatient MRM for these types of patients.

Timeline

Before the radical mastectomy:

  • Patient undergoes various diagnostic tests such as mammograms, ultrasounds, and biopsies to confirm the presence of breast cancer.
  • Patient may receive chemotherapy or radiation therapy to shrink the tumor before surgery.
  • Patient meets with a surgeon to discuss the surgical procedure and potential risks and benefits.
  • Patient undergoes pre-operative tests and preparations for surgery.

After the radical mastectomy:

  • Patient is monitored closely for any signs of complications such as infection or bleeding.
  • Patient may experience pain, swelling, and limited arm movement in the affected side.
  • Patient may require physical therapy to regain strength and mobility in the arm and shoulder on the affected side.
  • Patient may undergo reconstructive surgery to restore the appearance of the breast.
  • Patient undergoes follow-up appointments and screenings to monitor for any signs of cancer recurrence.

What to Ask Your Doctor

Some questions a patient should ask their doctor about radical mastectomy may include:

  1. What are the potential risks and benefits of undergoing a radical mastectomy compared to other treatment options?
  2. What is the expected recovery time after a radical mastectomy and what can I do to help speed up my recovery?
  3. Will I need any additional treatments such as chemotherapy or radiation therapy after the surgery?
  4. How will a radical mastectomy affect my daily activities, such as work, exercise, and caring for my family?
  5. Are there any alternative surgical techniques or approaches that could be considered for my specific case?
  6. What are the chances of the cancer returning after a radical mastectomy and what follow-up care will be needed?
  7. How many radical mastectomies have you performed and what is your success rate?
  8. Will I be able to have breast reconstruction surgery after a radical mastectomy and what are the options available to me?
  9. What is the difference in outcomes between having a radical mastectomy performed in a hospital versus as an outpatient procedure?
  10. What is the cost difference between inpatient and outpatient radical mastectomy and how will this impact my financial situation?

Reference

Authors: Bryan AF, Castillo-Angeles M, Minami C, Laws A, Dominici L, Broyles J, Friedlander DF, Ortega G, Jarman MP, Weiss A. Journal: Ann Surg Oncol. 2023 Aug;30(8):4637-4643. doi: 10.1245/s10434-023-13588-z. Epub 2023 May 11. PMID: 37166742