RANDOMIZED CONTROLLED TRIAL OF EFFECTS OF EARLY DISCHARGE AFTER SURGERY FOR BREAST-CANCER

Objective To determine the effect of early discharge from hospital aft er surgery for breast cancer on physical and psychological illness. De sign Randomised controlled trial comparing discharge two days after su rgery (before removal of drain) with standard management (discharge af ter removal of drain). Setting Regional breast unit. Subjects 100 wome n with early breast cancer undergoing mastectomy and axillary node cle arance (20) or breast conservation surgery (80). Main outcome measures Physical illness (infection seroma formation, shoulder movement) and psychological illness (checklist of concerns, Rotterdam symptom questi onnaire, hospital anxiety and depression scale) preoperatively and at one month and three months postoperatively. Results Women discharged e arly had greater shoulder movement (odds ratio 0.28 (95% confidence in terval 0.08 to 0.95); P = 0.042) and less wound pain (odds ratio 0.28 (0.10 to 0.79); P = 0.016) three months after surgery compared with wo men given standard management. One month after surgery scores were sig nificantly lower on the Rotterdam symptom questionnaire in patients wh o were discharged early (ratio of geometric mean scores 0.73 (0.55 to 0.98); P = 0.035), but rates of psychological illness generally did no t differ between groups. Conclusions Increased rates of physical or ps ychological illness did not result from early discharge after surgery for breast cancer. This policy can be recommended for patients with su pport at home.