Enhancing the Clinical Pathway for Patients…
This study describes safe conversion of axillary lymph node dissection (ALND) as a day-case procedure without compromising patient care – excluding patients who underwent concurrent mastectomy or reconstruction surgery. This was devised in the multidisciplinary setting (2009-2010) and involved better education to medical staff and patients, provision of post-operative drain-care instructions, and teaching of upper limb exercise techniques. All patients were called by a nurse within 24 hours of surgery, and any patients with concerning symptoms were called back to the clinic. Drains were removed when the output was less than 30ml in two consecutive days. All complications occurring within 30 days of surgery was recorded prospectively on to a hospital database. Out of 282 patients, 240 patients underwent day-case ALND (85.1%). The re-operation rate was 0.7%; both cases were due to haematomas identified in the post-operative recovery area. Therefore, they did not require re-admission. The re-admission rate was 0.8% in the day-case ALND group. The 30 day complication for the study period was 3.3%. This was comparable to 3.5% in the previous year.
The Breast 2012, DOI: 10.1016/j.breast.2011.10.002
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