Annals of Surgical Oncology

, Volume 26, Issue 10, pp 3354–3360 | Cite as

Same-Day Surgery for Mastectomy Patients in Alberta: A Perioperative Care Pathway and Quality Improvement Initiative

  • Alysha R. Keehn
  • David W. Olson
  • Joseph C. Dort
  • Shannon Parker
  • Susan Anderes
  • Lynn Headley
  • Adam Elwi
  • Angela Estey
  • Alysha Crocker
  • Alison Laws
  • May Lynn QuanEmail author
Breast Oncology



Same-day surgery (SDS) following mastectomy is safe and well accepted. Overnight admission in patients fit for discharge is an inefficient use of health resources. In response to a national review highlighting SDS following mastectomy at 1.4% in Alberta, a perioperative pathway was conceived.


The pathway was implemented across Alberta at 13 hospitals beginning in 2016. A steering committee was assembled, and clinical and administrative leads at each site were identified. Opportunities along the patient care experience whereby action could be taken to promote uptake of SDS were identified. Provincially branded support materials including presentations, order sets, and standard operating procedures were developed. Nurse educators provided in-service teaching such as standardized drain care and discharge teaching. Educational booklets, group classes, and online resources were developed for patients and families. An audit of SDS rates, unscheduled return to the emergency department (ED), and readmission rates was reported to teams quarterly, allowing for iterative modifications. Patient-reported experience measures (PREMs) were collected.


SDS following mastectomy increased from 1.7 to 47.8%, releasing an estimated 831 bed days per year. No differences in unexpected return to the ED or readmission to hospital existed between SDS patients and those admitted overnight. A total of 102 patients completed the PREM survey, of whom 90% felt “excellent or good” with the plan to go home, how to care for themselves once home, and who to contact should issues arise.


Implementation of a provincial perioperative pathway improved uptake of SDS following mastectomy and demonstrated favorable PREMs.



We would like to take the time to acknowledge the many contributions that supported this work including members of the CSCN, the Provincial Steering Committee Members, the clinical and administrative champions at the hospitals involved, and the two public advisors who sat on the Provincial Steering Committee.


The authors of this work have no commercial interests to disclose. This initiative was provincially funded by Alberta Health Services through the Cancer Strategic Clinical Network (SCN).


  1. 1.
    Canadian Cancer Society’s Steering Committee on Cancer Statistics. Canadian cancer statistics 2017. Toronto: Canadian Cancer Society; (2017).Google Scholar
  2. 2.
    Alberta Health Services. Surveillance & reporting: 2012 report on cancer statistics in Alberta. Edmonton: Cancer Control Alberta, Alberta Health Services; (2015).Google Scholar
  3. 3.
    Alberta Health Services Tableau Dashboard. Mastectomy rate in Alberta. (2019).
  4. 4.
    Margolese RG, Lasry JC. Ambulatory surgery for breast cancer patients. Ann Surg Oncol. 2000;7(3):181–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Goodman AA, Mendez AL. Definitive surgery for breast cancer performed on an outpatient basis. Arch Surg. 1993;128(10):1149–52.CrossRefPubMedGoogle Scholar
  6. 6.
    Seltzer MH. Partial mastectomy and limited axillary dissection performed as a same day surgical procedure in the treatment of breast cancer. Int Surg. 1995;80(1):79–81.PubMedGoogle Scholar
  7. 7.
    Dravet F, Belloin J, Dupre PF, Fracois T, Robard S, Theard JL, Classe JM. Role of outpatient surgery in breast surgery. Prospective feasibility study. Ann Chir. 2000;125(7): 668–76.CrossRefPubMedGoogle Scholar
  8. 8.
    Dooley WC. Ambulatory breast cancer surgery. Am J Surg. 2002;184(6):545–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Friedman D. Definitive breast cancer surgery as an outpatient: rationale and our experience. Ann Ital Chir. 2004;75(5):525–8.PubMedGoogle Scholar
  10. 10.
    Wells M, Harrow A, Donnan P, et al. Patient, carer and health service outcomes of nurse-led early discharge after breast cancer surgery: a randomised controlled trial. Br J Cancer. 2004;91(4):651–8.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Athey N, Gilliam D, Sinha P, Kurup VJ, Hennessey C, Leaper DJ. Day-case breast cancer axillary surgery. Ann R Coll Surg Engl. 2005;87(2):96–8.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Carcano G, Uccella L, Ferrari A, et al. Breast cancer surgery as an outpatient in Italy: is it possible? Chir (Buchur). 2005;18:323–5.Google Scholar
  13. 13.
    Marchal F, Dravet F, Classe J, et al. Post-operative care and patient satisfaction after ambulatory surgery for breast cancer patients. Eur J Surg Oncol. 2005;31(5):495–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Marla S, Stallard S. Systematic review of day surgery for breast cancer. Int J Surg. 2009;7(4):318–23.CrossRefPubMedGoogle Scholar
  15. 15.
    Weber W, Barry M, Junqueira M, Lee S, Mazella A, Sclafani L. Initial experiences with a multidisciplinary approach to decreasing the length of hospital stay for patients undergoing unilateral mastectomy. Eur J Surg Oncol. 2011;37(11):944–49.CrossRefPubMedGoogle Scholar
  16. 16.
    Cordeiro E, Jackson T, Cil T. Same-day major breast cancer surgery is safe: an analysis of short-term outcomes using NSQIP data. Ann Surg Oncol. 2016;23(8):2480–6.CrossRefPubMedGoogle Scholar
  17. 17.
    Duriaud H, Kroman N, Kehlet H. Feasibility and safety of outpatient breast cancer surgery. Dan Med J. 2018;65(3):A5458.PubMedGoogle Scholar
  18. 18.
    Ny Y, Chan P, Chen J, Seah M, Teo C, Tan E. Adopting ambulatory breast cancer surgery as the standard of care in an Asian population. Int J Breast Cancer. 2014;672743.Google Scholar
  19. 19.
    Robson N, Cutress R, Sainsbury R, Rew D, Royle G. Implementation of a short-stay programme after breast cancer surgery. Br J Surg. 2010;97:189–94.CrossRefGoogle Scholar
  20. 20.
    Ballardini B, Cavalli M, Manfredi G, et al. Surgical treatment of breast lesions at a day center: experience of the European Institute of Oncology. Breast. 2016;27:169–74.CrossRefPubMedGoogle Scholar
  21. 21.
    Marrazzo A, Taormina P, David M, et al. Surgical treatment of early breast cancer in day surgery. Chir Ital. 2007;59(5):687–91.PubMedGoogle Scholar
  22. 22.
    Bian J, Halpern, M. Trends in outpatient breast cancer surgery among Medicare fee-for-service patients in the United States from 1993–2002. Chin J Cancer. 2011;30(3):197–203.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Case C, Johantgen M, Steiner C. Outpatient mastectomy: clinical, payer and geographic influences. Health Serv Res. 2001;36(5):869–84.PubMedPubMedCentralGoogle Scholar
  24. 24.
    de Kok M, Dirksen CD, Kessel AG, et al. Cost-effectiveness of a short stay admission programme for breast cancer surgery. Acta Oncol. 2010;49(3):338–46.CrossRefPubMedGoogle Scholar
  25. 25.
    Canadian Partnership Against Cancer: Examining disparities in cancer control: a system performance special focus report. (2014). Accessed 9 April 2019.
  26. 26.
    Porter G, Wagar B, Bryant H, et al. Rates of breast cancer surgery in Canada from 2007/08 to 2009/10: a retrospective cohort study. CMAJ Open. 2014;2(2):102–8.CrossRefGoogle Scholar
  27. 27.
    Straus SE, Tetroe J, Graham ID. Knowledge translation in health care: moving from evidence to practice (2nd ed). Oxford: BMJ Books; 2013.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Alysha R. Keehn
    • 1
    • 2
  • David W. Olson
    • 3
  • Joseph C. Dort
    • 1
    • 2
    • 4
  • Shannon Parker
    • 5
  • Susan Anderes
    • 5
  • Lynn Headley
    • 5
  • Adam Elwi
    • 5
  • Angela Estey
    • 5
  • Alysha Crocker
    • 6
  • Alison Laws
    • 1
  • May Lynn Quan
    • 1
    • 2
    • 4
    Email author
  1. 1.Department of Surgery, Foothills Medical CentreUniversity of CalgaryCalgaryCanada
  2. 2.Department of Community Health SciencesUniversity of CalgaryCalgaryCanada
  3. 3.Department of SurgeryUniversity of AlbertaEdmontonCanada
  4. 4.Department of OncologyUniversity of CalgaryCalgaryCanada
  5. 5.Cancer Strategic Clinical NetworkAlberta Health ServicesEdmontonCanada
  6. 6.Surveillance and ReportingAlberta Health ServicesCalgaryCanada

Personalised recommendations