BMJ 1998;316:1267-1271 ( 25 April )

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Medical and psychosocial effects of early discharge after surgery for breast cancer: randomised trial

Jorien Bonnema, surgeon, a Anneke M E A van Wersch, social psychologist, b Albert N van Geel, surgeon, a Jean F A Pruyn, social psychologist, b Paul I M Schmitz, statistician, a Marinus A Paul, surgeon, a Theo Wiggers, surgeon. a

a Department of Surgical Oncology, University Hospital Rotterdam/Daniel den Hoed Cancer Center, Zuider Hospital Rotterdam, PO Box 5201, 3008 AE Rotterdam, Netherlands, b Institute for Health and Environmental Issues, PO Box 71, 4797 ZH Willemstad, Netherlands

Correspondence to: Mrs Bonnema wiggers{at}chih.azr.nl

Objective: To assess the medical and psychosocial effects of early hospital discharge after surgery for breast cancer on complication rate, patient satisfaction, and psychosocial outcomes.
Design: Randomised trial comparing discharge from hospital 4 days after surgery (with drain in situ) with discharge after drain removal (mean 9 days in hospital). Psychosocial measurements performed before surgery and 1 and 4 months after.
Setting: General hospital and cancer clinic in Rotterdam with a socioeconomically diverse population.
Subjects: 125 women with operable breast cancer.
Main outcome measures: Incidence of complications after surgery for breast cancer, patient satisfaction with treatment, and psychosocial effects of short stay or long stay in hospital.
Results: Patient satisfaction with the short stay in hospital was high; only 4% (2/56 at 1 month after surgery and 2/52 at 4 months after surgery) of patients indicated that they would have preferred a longer stay. There were no significant differences in duration of drainage from the axilla between the short stay and long stay groups (median 8 v 9 days respectively, P=0.45) or the incidence of wound complications (10 patients v 9 patients). The median number of seroma aspirations per patient was higher for the long stay group (1 v 3.5, P=0.04). Leakage along the drain occurred more frequently in short stay patients (21 v 10 patients, P=0.04). The two groups did not differ in scores for psychosocial problems (uncertainty, anxiety, loneliness, disturbed sleep, loss of control, threat to self esteem), physical or psychological complaints, or in the coping strategies used. Before surgery, short stay patients scored higher on scales of depression (P=0.03) and after surgery they were more likely to discuss their disease with their families (at 1 month P=0.004, at 4 months P=0.04).
Conclusions: Early discharge from hospital after surgery for breast cancer is safe and is well received by patients. Early discharge seems to enhance the opportunity for social support within the family.

Key messages

  • Early discharge from hospital after breast cancer surgery does not lead to an increase in the incidence of wound infection or seroma formation

  • A short stay in hospital, with support from community nurses on the patient's return home, is acceptable to patients

  • Psychosocial rehabilitation is not influenced by early discharge

  • Recovery in the family environment may facilitate discussion of the illness

  • Patients recovering from surgery for breast cancer need not spend more than three days in hospital provided that they are in good physical condition and there is adequate nursing support available in the community



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Medical and psychological effects of early discharge after surgery for breast cancer
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