Safety and Racial Implications of Same-Day Discharge in Alloplastic Breast Reconstruction Following the COVID-19 Pandemic.

Overview

abstract

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic was an unprecedented period that fundamentally reshaped healthcare delivery worldwide. Among the significant changes was a shift toward same-day discharge (SDD) across all surgical specialties. This study focuses on immediate alloplastic reconstruction, with the objectives to quantify the increase in SDDs, evaluate the associated safety outcomes, and investigate racial disparities resulting from these changes. METHODS: Using data from the National Surgical Quality Improvement Program (NSQIP) database, we conducted a retrospective analysis of patients who underwent mastectomies with immediate alloplastic reconstructions from 2018 to 2022. Patients were categorized by length of stay as SDD (0 day) or inpatient (≥1 day) and divided into pre-COVID (2018-2019) and post-COVID (2020-2022) phases. To assess patient safety, we compared complication rates between SDD and inpatient cases as well as across pre- and post-COVID periods. To evaluate racial disparities, we performed unmatched and matched comparisons of outcomes between Caucasian and Black patients. Limited statistical power precluded analysis of other racial groups. RESULTS: A total of 31,458 patients were identified. The proportion of SDD cases increased from 9.3% pre-COVID to 31.9% post-COVID, representing a 3.43-fold rise. In this study, SDD was found to be as safe as, if not safer than, inpatient procedures, with significantly lower rates of reoperation (5.5% vs 8.6%), readmission (3.9% vs 4.9%), and postoperative transfusions (0.1% vs 1.0%) (P < 0.001). Post-COVID SDD outcomes were also comparable to pre-COVID benchmarks. Following the pandemic, racial disparities persisted in the inpatient setting, with Black patients experiencing significantly higher rates of wound dehiscence and postoperative transfusions than Caucasian patients. In contrast, among SDD cases, complication rates were similar across racial groups in the unmatched analysis, while the matched analysis revealed lower rates of surgical site complications and reoperations in Black patients. CONCLUSIONS: Since the onset of COVID-19, SDD in immediate alloplastic reconstruction has increased by 22.6%. Despite this rapid transition, SDD has demonstrated promising outcomes, upholding both safety and equity considerations.