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Breast Cancer Research and Treatment

Erschienen in:

19.06.2020 | COVID-19 | Clinical trial Zur Zeit gratis

High-Efficiency Same-Day Approach to Breast Reconstruction During the COVID-19 Crisis

verfasst von: Michelle Specht, Nikhil Sobti, Nikki Rosado, Eleanor Tomczyk, Olivia Abbate, Dan Ellis, Eric C. Liao

Erschienen in: Breast Cancer Research and Treatment | Ausgabe 3/2020

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Abstract

Purpose

As our hospitals conserve and re-allocate resources during the COVID-19 crisis, there is urgent need to determine how best to continue caring for breast cancer patients. During the time window before the COVID-19 critical peak and particularly thereafter, as hospitals are able to resume cancer operations, we anticipate that there will be great need to maximize efficiency to treat breast cancer. The goal of this study is to present a same-day protocol that minimizes resource utilization to enable hospitals to increase inpatient capacity, while providing care for breast cancer patients undergoing mastectomy and immediate breast reconstruction during the COVID-19 crisis.

Methods

IRB exempt patient quality improvement initiative was conducted to detail the operationalization of a novel same-day breast reconstruction protocol. Consecutive patients having undergone immediate breast reconstruction were prospectively enrolled between February and March of 2020 at Massachusetts General Hospital during the COVID-19 crisis. Peri-operative results and postoperative complications were summarized.

Results

Time interval from surgical closure to patient discharge was 5.02 ± 1.29 h. All patients were discharged home, with no re-admissions or emergency department visits. No postoperative complications were observed.

Conclusion

This report provides an instruction manual to operationalize a same-day breast reconstruction protocol, to meet demands of providing appropriate cancer treatment during times of unprecedented resource limitations. Pre-pectoral implant-based breast reconstruction can be the definitive procedure or be used as a bridge to autologous reconstruction. Importantly, we hope this work will be helpful to our patients and community as we emerge from the COVID-19 pandemic.

Nur mit Berechtigung zugänglich

Brindle M, Gawande A (2020) Managing COVID-19 in Surgical Systems. Ann Surg. https://doi.org/10.1097/SLA.0000000000003923 CrossRefPubMed

Emanuel EJ, Persad G, Upshur R, Thome B, Parker M, Glickman A, Zhang C, Boyle C, Smith M, Phillips JP (2020) Fair Allocation of Scarce Medical Resources in the Time of Covid-19. N Engl J Med. https://doi.org/10.1056/NEJMsb2005114 CrossRefPubMed

Ji Y, Ma Z, Peppelenbosch MP, Pan Q (2020) Potential association between COVID-19 mortality and health-care resource availability. Lancet Glob Health 8(4):e480. https://doi.org/10.1016/S2214-109X(20)30068-1 CrossRefPubMedPubMedCentral

Timbie JW, Ringel JS, Fox DS, Waxman DA, Pillemer F, Carey C, Moore M, Karir V, Johnson TJ, Iyer N, Hu J, Shanman R, Larkin JW, Timmer M, Motala A, Perry TR, Newberry S, Kellermann AL (2012) Allocation of scarce resources during mass casualty events. Evid Rep Technol Assess (Full Rep) 207:1–305

Persad G, Wertheimer A, Emanuel EJ (2009) Principles for allocation of scarce medical interventions. Lancet 373(9661):423–431. https://doi.org/10.1016/S0140-6736(09)60137-9 CrossRefPubMed

Biddison ELD, Gwon HS, Schoch-Spana M, Regenberg AC, Juliano C, Faden RR, Toner ES (2018) Scarce resource allocation during disasters: a mixed-method community engagement study. Chest 153(1):187–195. https://doi.org/10.1016/j.chest.2017.08.001 CrossRef

American Society of Plastic Surgeons (2020) ASPS Statement on Breast Reconstruction in the face of COVID-19 Pandemic. https://www.plasticsurgeryorg/. Accessed 2 April 2020.

Kadhim M, Gans I, Baldwin K, Flynn J, Ganley T (2016) Do surgical times and efficiency differ between inpatient and ambulatory surgery centers that are both hospital owned? J Pediatr Orthop 36(4):423–428. https://doi.org/10.1097/BPO.0000000000000454 CrossRefPubMed

Panda N, Solsky I, Haynes AB (2019) Redefining shared decision-making in the digital era. Eur J Surg Oncol 45(12):2287–2288. https://doi.org/10.1016/j.ejso.2019.07.025 CrossRefPubMed

10.

Cordeiro E, Jackson T, Cil T (2016) Same-day major breast cancer surgery is safe: an analysis of short-term outcomes using NSQIP data. Ann Surg Oncol 23(8):2480–2486. https://doi.org/10.1245/s10434-016-5128-0 CrossRefPubMed

11.

Cordeiro E, Zhong T, Jackson T, Cil T (2017) The safety of same-day breast reconstructive surgery: an analysis of short-term outcomes. Am J Surg 214(3):495–500. https://doi.org/10.1016/j.amjsurg.2016.11.015 CrossRefPubMed

12.

McGugin CJ, Coopey SB, Smith BL, Kelly BN, Brown CL, Gadd MA, Hughes KS, Specht MC (2019) Enhanced recovery minimizes opioid use and hospital stay for patients undergoing mastectomy with reconstruction. Ann Surg Oncol 26(11):3464–3471. https://doi.org/10.1245/s10434-019-07710-3 CrossRefPubMed

13.

Vuong B, Graff-Baker AN, Yanagisawa M, Chang SB, Mentakis M, Shim V, Knox M, Romero L, Kuehner G (2019) Implementation of a post-mastectomy home recovery program in a large, integrated health care delivery system. Ann Surg Oncol 26(10):3178–3184. https://doi.org/10.1245/s10434-019-07551-0 CrossRefPubMed

14.

Keehn AR, Olson DW, Dort JC, Parker S, Anderes S, Headley L, Elwi A, Estey A, Crocker A, Laws A, Quan ML (2019) Same-day surgery for mastectomy patients in Alberta: a perioperative care pathway and quality improvement initiative. Ann Surg Oncol 26(10):3354–3360. https://doi.org/10.1245/s10434-019-07568-5 CrossRef

15.

Sobti N, Weitzman RE, Nealon KP, Jimenez RB, Gfrerer L, Mattos D, Ehrlichman RJ, Gadd M, Specht M, Austen WG, Liao EC (2020) Evaluation of capsular contracture following immediate pre-pectoral versus subpectoral direct-to-implant breast reconstruction. Sci Rep 10(1):1137. https://doi.org/10.1038/s41598-020-58094-4 CrossRefPubMedPubMedCentral

16.

Gfrerer L, Liao EC (2018) Technique refinement in pre-pectoral implant breast reconstruction with vicryl mesh pocket and acellular dermal matrix support. Plast Reconstr Surg Glob Open 6(4):e1749. https://doi.org/10.1097/GOX.0000000000001749 CrossRefPubMedPubMedCentral

17.

Srinivasa DR, Holland M, Sbitany H (2019) Optimizing perioperative strategies to maximize success with pre-pectoral breast reconstruction. Gland Surg 8(1):19–26. https://doi.org/10.21037/gs.2018.09.10 CrossRefPubMedPubMedCentral

18.

Shahbazi S, Woods SJ (2016) Influence of physician, patient, and health care system characteristics on the use of outpatient mastectomy. Am J Surg 211(4):802–809. https://doi.org/10.1016/j.amjsurg.2015.10.021 CrossRefPubMed

19.

Qin C, Antony AK, Aggarwal A, Jordan S, Gutowski KA, Kim JY (2015) Assessing outcomes and safety of inpatient versus outpatient tissue expander immediate breast reconstruction. Ann Surg Oncol 22(11):3724–3729. https://doi.org/10.1245/s10434-015-4407-5 CrossRefPubMed

20.

Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, Ren R, Leung KSM, Lau EHY, Wong JY, Xing X, Xiang N, Wu Y, Li C, Chen Q, Li D, Liu T, Zhao J, Liu M, Tu W, Chen C, Jin L, Yang R, Wang Q, Zhou S, Wang R, Liu H, Luo Y, Liu Y, Shao G, Li H, Tao Z, Yang Y, Deng Z, Liu B, Ma Z, Zhang Y, Shi G, Lam TTY, Wu JT, Gao GF, Cowling BJ, Yang B, Leung GM, Feng Z (2020) Early transmission dynamics in Wuhan, China, of novel Coronavirus-infected pneumonia. N Engl J Med 382(13):1199–1207. https://doi.org/10.1056/NEJMoa2001316 CrossRefPubMedPubMedCentral

21.

Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, Wang B, Xiang H, Cheng Z, Xiong Y, Zhao Y, Li Y, Wang X, Peng Z (2020) Clinical Characteristics of 138 hospitalized patients with 2019 Novel Coronavirus-infected pneumonia in Wuhan, China. JAMA. https://doi.org/10.1001/jama.2020.1585 CrossRefPubMedPubMedCentral

22.

Bian J, Krontiras H, Allison J (2008) Outpatient mastectomy and breast reconstructive surgery. Ann Surg Oncol 15(4):1032–1039. https://doi.org/10.1245/s10434-007-9762-4 CrossRefPubMed

23.

Kruper L, Xu XX, Henderson K, Bernstein L, Chen SL (2013) Utilization of mastectomy and reconstruction in the outpatient setting. Ann Surg Oncol 20(3):828–835. https://doi.org/10.1245/s10434-012-2661-3 CrossRefPubMed

24.

Seth AK, Hirsch EM, Kim JY, Dumanian GA, Mustoe TA, Galiano RD, Fine NA (2013) Hematoma after mastectomy with immediate reconstruction: an analysis of risk factors in 883 patients. Ann Plast Surg 71(1):20–23. https://doi.org/10.1097/SAP.0b013e318243355f CrossRefPubMed

25.

Nahabedian MY, Tsangaris T, Momen B, Manson PN (2003) Infectious complications following breast reconstruction with expanders and implants. Plast Reconstr Surg 112(2):467–476. https://doi.org/10.1097/01.PRS.0000070727.02992.54 CrossRefPubMed

26.

Fischer JP, Wes AM, Tuggle CT, Nelson JA, Tchou JC, Serletti JM, Kovach SJ, Wu LC (2014) Mastectomy with or without immediate implant reconstruction has similar 30-day perioperative outcomes. J Plast Reconstr Aesthet Surg 67(11):1515–1522. https://doi.org/10.1016/j.bjps.2014.07.021 CrossRefPubMed

27.

Fischer JP, Nelson JA, Au A, Tuggle CT 3rd, Serletti JM, Wu LC (2014) Complications and morbidity following breast reconstruction–a review of 16,063 cases from the 2005–2010 NSQIP datasets. J Plast Surg Hand Surg 48(2):104–114. https://doi.org/10.3109/2000656X.2013.819003 CrossRefPubMed

28.

Wink JD, Fischer JP, Nelson JA, Serletti JM, Wu LC (2014) Direct-to-implant breast reconstruction: an analysis of 1612 cases from the ACS-NSQIP surgical outcomes database. J Plast Surg Hand Surg 48(6):375–381. https://doi.org/10.3109/2000656X.2014.899240 CrossRefPubMed

29.

Alderman AK, Wilkins EG, Kim HM, Lowery JC (2002) Complications in postmastectomy breast reconstruction: two-year results of the Michigan Breast Reconstruction Outcome Study. Plast Reconstr Surg 109(7):2265–2274CrossRefPubMed

30.

Allen RJJ, Sobti N, Patel A, Matros E, McCarthy CM, Dayan JH, Disa JJ, Mehrara BJ, Morrow M, Pusic AL, Nelson JA (2020) Laterality and patient-reported outcomes following autologous breast reconstruction with free abdominal tissue: an 8-year examination of BREAST-Q data. Plast Reconstr Surg In Press

31.

King TA, Sakr R, Patil S, Gurevich I, Stempel M, Sampson M, Morrow M (2011) Clinical management factors contribute to the decision for contralateral prophylactic mastectomy. J Clin Oncol 29(16):2158–2164. https://doi.org/10.1200/JCO.2010.29.4041 CrossRefPubMed

32.

Portschy PR, Kuntz KM, Tuttle TM (2014) Survival outcomes after contralateral prophylactic mastectomy: a decision analysis. J Natl Cancer Inst. https://doi.org/10.1093/jnci/dju160 CrossRefPubMed

33.

Nealon KP, Weitzman RE, Sobti N, Gadd M, Specht M, Jimenez RB, Ehrlichman R, Faulkner HR, Austen WG Jr, Liao EC (2020) Pre-pectoral direct-to-implant breast reconstruction: safety outcome endpoints and delineation of risk factors. Plast Reconstr Surg 145(5):898e–908e. https://doi.org/10.1097/PRS.0000000000006721 CrossRef

34.

Nealon KP, Sobti N, Gadd M, Specht M, Liao EC (2020) Assessing the additional surgical risk of contralateral prophylactic mastectomy and immediate breast implant reconstruction. Breast Cancer Res Treat 179(2):255–265. https://doi.org/10.1007/s10549-019-05460-0 CrossRefPubMed

35.

Madsen RJ, Esmonde NO, Ramsey KL, Hansen JE (2016) Axillary lymph node dissection is a risk factor for major complications after immediate breast reconstruction. Ann Plast Surg 77(5):513–516. https://doi.org/10.1097/SAP.0000000000000653 CrossRefPubMed

36.

Lucci A, McCall LM, Beitsch PD, Whitworth PW, Reintgen DS, Blumencranz PW, Leitch AM, Saha S, Hunt KK, Giuliano AE, American College of Surgeons Oncology G (2007) Surgical complications associated with sentinel lymph node dissection (SLND) plus axillary lymph node dissection compared with SLND alone in the American College of Surgeons Oncology Group Trial Z0011. J Clin Oncol 25(24):3657–3663. https://doi.org/10.1200/JCO.2006.07.4062 CrossRefPubMed

37.

Sobti N, Ji E, Brown RL, Cetrulo CL Jr, Colwell AS, Winograd JM, Austen WG Jr, Liao EC (2018) Evaluation of acellular dermal matrix efficacy in prosthesis-based breast reconstruction. Plast Reconstr Surg 141(3):541–549. https://doi.org/10.1097/PRS.0000000000004109 CrossRefPubMed

38.

Grippaudo FR, Renzi L, Costantino B, Longo B, Santanelli F (2013) Late unilateral hematoma after breast reconstruction with implants: case report and literature review. Aesthet Surg J 33(6):830–834. https://doi.org/10.1177/1090820X13496249 CrossRefPubMed

Titel: High-Efficiency Same-Day Approach to Breast Reconstruction During the COVID-19 Crisis
verfasst von: Michelle Specht
Nikhil Sobti
Nikki Rosado
Eleanor Tomczyk
Olivia Abbate
Dan Ellis
Eric C. Liao
Publikationsdatum: 19.06.2020
Verlag: Springer US
Schlagwort: COVID-19
Erschienen in: Breast Cancer Research and Treatment / Ausgabe 3/2020
Print ISSN: 0167-6806
Elektronische ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-020-05739-7

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High-Efficiency Same-Day Approach to Breast Reconstruction During the COVID-19 Crisis