TRENDS AND OUTCOMES OF OUTPATIENT MASTECTOMY IN ELDERLY WOMEN

Background: Considerable public attention has focused on the use of ou tpatient mastectomy and has resulted in numerous legislative proposals to mandate a minimum hospital stay following mastectomy, To date, onl y limited scientific data are available regarding the use and the outc omes of outpatient mastectomy, The purpose of this study was to provid e population-based information on trends and outcomes for outpatient m astectomy in elderly women. Methods: Medicare data for elderly women w ith fee-for-service coverage were examined for trends and regional var iation in the use of outpatient mastectomy, Logistic regression was us ed to identify patient and provider characteristics associated with ha ving an outpatient mastectomy, and outcomes were assessed by calculati ng the risk of being rehospitalized and the reasons for rehospitalizat ion. Results: From 1986 through 1995, the proportion of mastectomies p erformed on an outpatient basis increased from virtually 0% to 10.8%, Outpatient mastectomies were more likely to be performed on women with no coexisting health problems in hospitals that were for-profit or no n-teaching or in large metropolitan statistical areas. Women undergoin g outpatient mastectomy had substantially higher rates of rehospitaliz ation within 30 days than women with a 1-day stay in the hospital. Bot h groups had comparable rates of rehospitalization for complications d efinitely related to their surgery. The percentage of women who requir ed rehospitalization was low, and the actual number of women rehospita lized was relatively small. Conclusions: We conclude that the risks fr om outpatient mastectomy are modest, although ongoing monitoring of ou tcomes and assessment of patient satisfaction are needed.