Patients can be discharged on second postoperative morning

EDITOR —Bonnema et al studied medical and psychological effects of early discharge after surgery for breast cancer.1 Their results agree with our experience of early discharge in a district general hospital in the United Kingdom.2

To compare the care received by the two groups it is necessary to know what facilities were afforded to the early discharge group. These details were lacking in the paper. We routinely provide domiciliary physiotherapy (which is important after axillary surgery) and specialist breast counselling to ensure that our patients at home receive the same treatment as those in hospital.

We are unsure why the authors chose four days as the discharge time for their early discharge group. After a pilot study we now routinely discharge all patients suitable for domiciliary care on the second postoperative morning. Ninety per cent of patients thought that this was an appropriate postoperative stay. Analysis of use of analgesia showed that patients required only oral analgesia at this time even after combined mastectomy and axillary surgery. What benefit is gained by the extra 48 hours in hospital?

The technique used by the authors to assess patient satisfaction is unusual. They recorded patients' preference for a longer or shorter stay rather than satisfaction with the treatment they received. The 37% who recommended early discharge without having experienced it may have been reflecting dissatisfaction with their own experience rather than perceived satisfaction with a different discharge policy. We found that 90% of patients thought that our early discharge facility was excellent.

No significant difference in postoperative psychosocial variables was noted by Bonnema et al at one and four months after surgery. At one month after surgery the early …