Rahi Karmarkar
Background
Day-case mastectomy is a safe, cost-effective pathway endorsed by the British Association of Day Surgery (BADS) and Getting It Right First Time programmes (GIRFT). Despite this, uptake remains inconsistent across UK breast units. This study evaluates day-case rates and identifies modifiable barriers to same-day discharge.
Methods
A retrospective evaluation of all mastectomies performed at Royal Stoke University Hospital and County Hospital (October 2024–September 2025) was undertaken. Data included procedure type, reconstruction, axillary surgery, admission status, and reasons for inpatient stay. Patients were categorised as day-case, planned, or unplanned admissions.
Results
Seventy-two mastectomies were analysed. Day-case surgery was achieved in 18 cases (25%), while 54 (75%) required admission. Of these, 43 (79.6%) were planned and only 11 (20.4%) unplanned. Planned admissions were predominantly due to comorbidity/age (n=14) and reconstruction (n=13). Procedure-specific analysis demonstrated high inpatient rates for reconstruction (83%) and axillary clearance (87.5%), whereas simple mastectomy had a day-case rate of 26%, highlighting a key target group. Unplanned admissions were infrequent and largely avoidable, most commonly due to late theatre finish; true complications were rare (2.8%).
Conclusion
Day-case mastectomy rates exceeded the national GIRFT average but remain below BADS benchmarks. Importantly, most admissions were planned and driven by modifiable factors rather than complications. Targeted interventions including pathway standardisation, early theatre scheduling, and improved pre-operative planning could safely increase day-case rates to 35–40%, delivering significant efficiency gains without compromising patient outcomes.
Authors
Rahi Karmarkar, Sadaf Jafferbhoy, Sekhar Marla
University Hospitals North Midlands, Stoke, United Kingdom