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AMBULATORY BREAST SURGERY: MAKING A DREAM A REALITY

AMBULATORY BREAST SURGERY: MAKING A DREAM A REALITY. MR ANIL J DESAI ONCOPLASTIC BREAST SURGEON AND BREAST CANCER LEAD SOUTH LONDON HEALTHCARE TRUST. WHY?. PATIENT FACTORS Guaranteed date, no cancellations Minimise SSI Better patient acceptance Psychological advantage Safe. WHY?.

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AMBULATORY BREAST SURGERY: MAKING A DREAM A REALITY

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  1. AMBULATORY BREAST SURGERY: MAKING A DREAM A REALITY MR ANIL J DESAI ONCOPLASTIC BREAST SURGEON AND BREAST CANCER LEAD SOUTH LONDON HEALTHCARE TRUST

  2. WHY? PATIENT FACTORS Guaranteed date, no cancellations Minimise SSI Better patient acceptance Psychological advantage Safe

  3. WHY? CLINICIAN FACTORS No cancellations Minimise SSI Greater throughput REDUCED LOS FREES UP INPATIENT BEDS Reduces length of safari ward round SAVINGS

  4. WHERE? • DAY SURGERY UNIT • Dedicated unit best • Trained motivated staff • No portering required • Quick turnover • Logistics • NO THREAT TO BEDS FROM EMERGENCIES

  5. HOW? All day list –range of cases Facilities Training Patient education Continued care at home Access to urgent outpatient appointments

  6. BREAST SURGERY - CONVENTIONAL EXCISION BIOPSY WIDE LOCAL EXCISION AND SNB/AXILLARY CLEARANCE SIMPLE MASTECTOMY MASTECTOMY AND SNB/AXILLARY CLEARANCE MICRODOCHECTOMY/HADFIELD PROCEDURE

  7. BREAST SURGERY-ONCOPLASTIC • BREAST CONSERVATION • PARTIAL BREAST RECONSTRUCTION • GLANDULAR MOBILISATION AND ADVANCEMENT/ROTATION • THERAPEUTIC MAMMAPLASTY • SYMMETRISATION • BREAST REDUCTION • BREAST AUGMENTATION • MASTOPEXY

  8. BREAST SURGERY-ONCOPLASTIC • BREAST RECONSTRUCTION • IMPLANT • EXTENDED LD FLAP • LD FLAP AND IMPLANT • PEDICLED TRAM, FREE TRAM, DIEP, SGAP • REVISION OF BREAST RECONTRUCTION • CAPSULOTOMY/IMPLANT EXCHANGE • SCAR REVISION • POCKET REVISION • GLANDULAR RESHAPING • NIPPLE RECONSTRUCTION

  9. DAY SURGERY UNIT CASEMIX (242 PROCEDURES)OCTOBER 2008-DEC 2009

  10. PRUH/OTC CASEMIX (118 procedures)OCT 2008- DEC 2009

  11. READMISSION RATEOCT 2008-DEC 2009 • 3 cases • Haematoma requiring evacuation • Allergic reaction to Patent Blue V • Delayed finish to list (mastopexy)

  12. SUMMARY Majority of breast surgery can be carried out as day surgery It is safe Patients prefer it Makes it easy to manage the service SCOPE Cross site learning – breaking down barriers Training of teams Reducing need for second operations (Sentinel lymph node analyser) Considering breast reconstructions in 23 hour day surgery setting

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