No place like home after mastectomy

When Adriana Sanchez-Ochoa was diagnosed with cancer in both breasts, she wasn’t sure what to make of a suggestion from breast surgeon Brooke Vuong, MD, that she could have a double mastectomy and not spend a single night in the hospital.

But after further conversation, Sanchez-Ochoa was reassured. Her doctor and care team described what to expect before, during, and after the surgery, and carefully addressed her questions and concerns.

“My care team is amazing. The biggest factor with being ready to go home was how they prepared me,” said Sanchez-Ochoa, a 58-year-old policy consultant from Elk Grove, California.

A better experience after surgery

For many patients coming out of surgery, home recovery presents the opportunity to recuperate in a comfortable environment with preferred meals, better sleep, and more familiar surroundings. However, according to Dr. Vuong, for a long time it had been standard practice for mastectomy patients to be admitted to the hospital and discharged the next day.

“As surgeons, we would visit our patients the next morning, and they would usually be ready to go,” Dr. Vuong said. “We thought, what’s the added benefit of staying overnight?”

In 2017, a team of Kaiser Permanente surgeons in Northern California launched an integrated program to offer more patients the opportunity to safely recover at home without overnight admission to the hospital.  

The program builds on Kaiser Permanente’s ERAS, or Enhanced Recovery After Surgery program, which allows a carbohydrate drink before surgery (rather than the traditional fast), reduces opioids in favor of local anesthetics and acetaminophen, and gets patients walking soon after surgery.

In addition, care teams set expectations early, educate patients and caregivers on the care and management of surgical drains at home, and follow up with patients after discharge by phone, video, or secure messaging.

“We make sure patients have excellent pain management and thorough preoperative teaching, and that they know how to access their care team providers after hours if necessary,” said breast surgeon Gillian Kuehner, MD.

A 2019 study authored by Drs. Vuong, Kuehner, and colleagues found that home recovery rates for Northern California mastectomy patients grew from 23% to 61% within 6 months of program launch, with no significant changes in emergency department visits, reoperations, or readmissions. That same year, Kaiser Permanente’s surgical home recovery programs were honored with the inaugural NCQA Innovation Award for improving value and quality of care.