BMJ 1998;317:1275-1279 ( 7 November )

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Randomised controlled trial of effects of early discharge after surgery for breast cancer

Editorial by Fallowfield

Nigel Bundred, reader in surgical oncology, a Peter Maguire, director, c Jill Reynolds, research assistant, a Jill Grimshaw, research nurse, a Julie Morris, statistician, b Lesley Thomson, breast care nurse, a Lester Barr, consultant surgeon, a Andrew Baildam, senior lecturer. a

a Department of Surgery, b Department of Medical Statistics, c Cancer Research Campaign Psychological Medicine Group, Christie Hospital NHS Trust, Manchester M20 4BX

Correspondence to: Mr Bundred bundredn{at}fs1.with.man.ac.uk

Objective: To determine the effect of early discharge from hospital after surgery for breast cancer on physical and psychological illness.
Design: Randomised controlled trial comparing discharge two days after surgery (before removal of drain) with standard management (discharge after removal of drain).
Setting: Regional breast unit.
Subjects: 100 women with early breast cancer undergoing mastectomy and axillary node clearance (20) or breast conservation surgery (80).
Main outcome measures: Physical illness (infection, seroma formation, shoulder movement) and psychological illness (checklist of concerns, Rotterdam symptom questionnaire, hospital anxiety and depression scale) preoperatively and at one month and three months postoperatively.
Results: Women discharged early had greater shoulder movement (odds ratio 0.28 (95% confidence interval 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 women given standard management. One month after surgery scores were significantly lower on the Rotterdam symptom questionnaire in patients who 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 not differ between groups.
Conclusions: Increased rates of physical or psychological illness did not result from early discharge after surgery for breast cancer. This policy can be recommended for patients with support at home.

Key messages

  • The average hospital stay after surgery for breast cancer is seven days in the United Kingdom

  • This study found that discharge two days after such surgery does not affect rate of complications

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

  • Psychosocial illness is not affected by early discharge

  • Early discharge home facilitates shoulder movement and reduces subsequent wound pain

  • Patients suitable for early discharge must have support from a relative at home and be in good physical health




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Rapid Responses:

Read all Rapid Responses

Not no null hypothesis
C O'Loughlin
bmj.com, 12 Nov 1998 [Full text]
early discharge after surgery for breast cancer
Diana Harcourt
bmj.com, 13 Nov 1998 [Full text]
More information needed
Becky Elliot
bmj.com, 12 Nov 1998 [Full text]
Observational bias
Andy Huang
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PT advise before discharge.
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