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Study Finds Increase in Outpatient Mastectomies for Breast Cancer (dateline October 8, 2001)

A newly published study found that more breast cancer patients are receiving mastectomies on an outpatient basis than in the past. During an outpatient mastectomy procedure, the patient leaves the facility after the breast is surgically removed and recovers at home instead of being admitted as an inpatient to a hospital. However, previous research has shown that women who have outpatient mastectomies tend to experience fewer side effects and are more satisfied with the procedure than patients who are admitted to the hospital after the surgery. Researchers found that geographical location and other factors, such as health insurance and additional medical conditions, are key in determining whether a woman undergoes a mastectomy as an inpatient or outpatient.

To conduct the study, Dr. Claudia Steiner of the Agency for Healthcare Research and Quality and her colleagues examined medical records from five U.S. states: Colorado, Connecticut, Maryland, New Jersey and New York. Between 1990 and 1996, a total of 110,000 complete mastectomies and 32,000 partial mastectomies were performed in the five states. A complete mastectomy involves removing the entire breast with its skin and nipple. A partial mastectomy involves removing a portion of the breast tissue and a margin of normal breast tissue.

Inpatient The patient is admitted to the hospital or surgical facility for the procedure so she can be closely monitored during and after surgery. The initial recovery takes place in the hospital or surgical facility.
Outpatient The patient is not admitted to the hospital or surgical facility during or after the procedure. Full recovery takes place at home.

The researchers found that several factors influenced whether a woman received an inpatient or outpatient mastectomy. For example, women without health insurance or those who were HMO members were 30% to 60% more likely to receive outpatient mastectomies than women with health insurance, Medicare, or Medicaid coverage. Dr. Steiner and her colleagues say there is a trend in U.S. healthcare for procedures such as complete mastectomies to be performed more often in an outpatient setting. In the late 1990s, a handful of HMOs tried to make outpatient mastectomies mandatory, causing an uproar among patients and medical professionals.

Another factor that determined whether or not a woman received an inpatient or outpatient mastectomy was geographical location. For example, in the study, women in Colorado were nearly nine times more likely to have outpatient mastectomies than women in New Jersey. Furthermore, women in Connecticut and New York were also more likely to receive outpatient mastectomies compared to women in New Jersey. The researchers also observed that that rate of partial mastectomies increased between 1990 and 1996, indicating a trend toward breast-conserving surgery in all of the states.

Finally, the women’s medical conditions played a role in the type of procedure they received. For instance, women with advanced/metastatic cancer, hypertension (high blood pressure), or diabetes tended to undergo mastectomies as inpatients while women without these conditions were more likely to receive outpatient mastectomies.

Yet, despite the increase in outpatient mastectomies, Dr. Steiner and her colleagues say that the majority of mastectomies are still being performed as inpatient procedures in the United States. In 2001, U.S. Representative Rosa DeLauro reintroduced legislation that would require all women who have mastectomies to receive coverage by their insurance company for more than one day in the hospital after the surgery.

However, recent studies have not shown that outpatient mastectomies are any less safe than inpatient mastectomies. In fact, in a study presented at the annual meeting of the Society of Surgical Oncology in 2000, researchers said that the majority of women who have a mastectomy on an outpatient basis experience fewer side effects and are more satisfied than women who are admitted to a hospital for the procedure. Researchers cite the psychological effects of an outpatient mastectomy as one of the greatest benefits for patients. In the study, women who had outpatient mastectomies said their spirits were lifted because they felt more control over their recovery and treatment options. Though physicians are concerned about insurance companies trying to persuade patients to have outpatient mastectomies to lower hospital costs, they maintain that the procedure is medically safe and feasible for many patients.

Breast cancer patients who are candidates for mastectomy should talk with their physicians about whether an inpatient or outpatient procedure is best for them. According to Dr. Steiner, while outpatient mastectomies are a viable option for some women, they do tend to require more visits to the physician and more dependence on family members and friends during the recovery process. After an inpatient mastectomy, the length of the subsequent hospital stay varies greatly from over a week to less than one day, depending on a patient’s condition. A lumpectomy, the surgical removal of the breast tumor and a surrounding margin of normal breast tissue, is also a treatment option for many patients with early-stage breast cancer. Lumpectomy usually involves the removal of less breast tissue than a partial mastectomy.

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