Same Day Discharges Among Elderly Mastectomy Patients: A Single Institution Prospective Study.

Background: Same-day mastectomy is safe and high value. However, patients ≥ 65 years are less likely to be discharged compared with younger patients. Our aim was to implement a protocol to increase the rate of elderly same-day discharge.

Patients and methods: Patients were screened by 5-factor modified frailty index and notification of frailty status was sent to surgeons. Patients with moderate-to-high frailty were encouraged to have prehabilitation. Chart review collected demographic/clinicopathologic variables, length of stay, and complications. The primary endpoint was same-day discharge, and sample size determination was 50 patients. Our discharge rate was compared with our historic rate (18.8% March 2022 to February 2023) by Fisher's exact test.

Results: From March 2023 to January 2024, 306 patients aged ≥ 65 years were screened. Overall, 55 patients underwent a total of 57 mastectomies (18.6%). Median age was 72 years (range: 65-99). Frailty scores ranged from 0 to 4. In total, 11 patients (19.3%) had a score of zero, 41 (71.9%) scored 1 or 2, and 5 patients (8.8%) scored 3 or 4. Seven patients were referred to geriatric oncology for prehabilitation: one non-frail, four with low frailty, and two with moderate frailty. The median length of stay (LOS) was 0 days (range: 0-21). Thirty-two mastectomies had same-day discharge (56.1%), significantly higher than historic data (P < 0.00001).

Conclusions: We increased same-day discharges for patients ≥ 65 years from 18.8% to 56.1%. This protocol included a simple frailty screening and a weekly email. Future directions include increasing the proportion of patients who receive geriatric oncology prehabilitation referrals and evaluating patient-reported outcomes.