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

Jorien Bonnema, Anna Van Wersch, Albert N. Van Geel, Jean F. Pruyn, Paul I. M. Schmitz, Marinus A. Paul, Theo Wiggers

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Abstract

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.
Original languageEnglish
Pages (from-to)1267-1271
JournalBMJ
Volume316
Publication statusPublished - 1998

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Breast Neoplasms
Patient Satisfaction
Length of Stay
Seroma
Loneliness
Axilla
Incidence
Ambulatory Surgical Procedures
Self Concept
General Hospitals
Social Support
Uncertainty
Drainage
Sleep
Anxiety
Outcome Assessment (Health Care)
Depression
Psychology
Wounds and Injuries
Population

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Bonnema, J., Van Wersch, A., Van Geel, A. N., Pruyn, J. F., Schmitz, P. I. M., Paul, M. A., & Wiggers, T. (1998). Medical and psychosocial effects of early discharge after surgery for breast cancer: randomised trial. BMJ, 316, 1267-1271.
Bonnema, Jorien ; Van Wersch, Anna ; Van Geel, Albert N. ; Pruyn, Jean F. ; Schmitz, Paul I. M. ; Paul, Marinus A. ; Wiggers, Theo. / Medical and psychosocial effects of early discharge after surgery for breast cancer: randomised trial. In: BMJ. 1998 ; Vol. 316. pp. 1267-1271.
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abstract = "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.",
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Bonnema, J, Van Wersch, A, Van Geel, AN, Pruyn, JF, Schmitz, PIM, Paul, MA & Wiggers, T 1998, 'Medical and psychosocial effects of early discharge after surgery for breast cancer: randomised trial', BMJ, vol. 316, pp. 1267-1271.

Medical and psychosocial effects of early discharge after surgery for breast cancer: randomised trial. / Bonnema, Jorien; Van Wersch, Anna; Van Geel, Albert N.; Pruyn, Jean F.; Schmitz, Paul I. M. ; Paul, Marinus A. ; Wiggers, Theo.

In: BMJ, Vol. 316, 1998, p. 1267-1271.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Medical and psychosocial effects of early discharge after surgery for breast cancer: randomised trial

AU - Bonnema, Jorien

AU - Van Wersch, Anna

AU - Van Geel, Albert N.

AU - Pruyn, Jean F.

AU - Schmitz, Paul I. M.

AU - Paul, Marinus A.

AU - Wiggers, Theo

N1 - Author can archive publisher's version/PDF.

PY - 1998

Y1 - 1998

N2 - 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.

AB - 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.

M3 - Article

VL - 316

SP - 1267

EP - 1271

JO - BMJ

JF - BMJ

SN - 0959-8138

ER -

Bonnema J, Van Wersch A, Van Geel AN, Pruyn JF, Schmitz PIM, Paul MA et al. Medical and psychosocial effects of early discharge after surgery for breast cancer: randomised trial. BMJ. 1998;316:1267-1271.