Abstract:
Background: Age discrimination in the provision of health and care services was banned in the UK in 2012. However there continue to be age related discrepancies in the prevalence, treatment and outcomes experienced by people with breast cancer. British Association of Day Surgery recommends Day surgery (‘Zero night stay’) for 50% of simple mastectomies (with or without axillary surgery). We aimed to use length of stay for simple mastectomy (with or without axillary surgery) as a surrogate marker for treatment for breast cancer to assess any factors, such as ASA status and surgeon, which can be relevant to patient’s age. Methods: Retrospective analysis of all simple mastectomies (with or without axillary surgery) that took place at Blackpool Victoria Hospital between 1st January 2018 and 31st December 2018, were analysed. Data were obtained from the stored digital archive as well as case notes. Statistical analysis was performed using Chi square, Student T test and One-way Anova. P value less than 0.05 was considered to be statically significant.
Results: A total of 82 simple mastectomies took place. Length of stay (range 0-39 nights) was as follows: 0 night (Daycase)= 32 (39%); 1 night= 36 (43.9%); 2 nights= 4 (4.8%); 3 nights= 3 3.6%; >3 nights= 7 (8.5%). Age of patients ranged from 34-95 years (mean 70.4 ±1 SD 13.5; median 72). Day case mastectomy was associated with younger (67.2 years ±1 SD 14.9) patients, compared to patients who stayed as inpatient (72.4 years ±1 SD 12.4) [p=0.04]. Inpatient stay was associated more with ASA 3 (11 out of 11; 100%), compared to ASA ≤2 (39 out of 71; 54.9%) [p=0.001]. Higher age was associated more with ASA 3 (81.6 years ±1 SD 10.6), compared to ASA ≤2 (68.6 years ±1 SD 13.2) [p=0.001]. Mean age distribution as per consultant (n=3) was as follows- (70.8 years ±1 SD 14.3; 68.8 years ±1 SD 13.7 and 72.5 years ±1 SD 12.4) [p=0.61]. Factors that restricted same day discharge included anticoagulation treatment, social factors, poor mobility, haematoma, bilateral surgery, COPD, poor pain control, nausea and vomiting. Conclusions: No ageism was noted in the practice of any surgeon. All surgeons performed simple mastectomies without any age discrimination. However a longer length of stay was associated with higher age group. Higher ASA grade was also noted to be associated with higher age. Study showed that day case mastectomies failed to meet the 50% mark as recommended by the guideline. Implementation of a dedicated pathway, based on multidisciplinary approach for optimisation of relevant co-morbidities and social factors would help improve the length of stay following mastectomy with or without axillary surgery
