Sabrina Poppy Barnes
Aim
To evaluate day case rates and unplanned hospital admissions following mastectomy and wide local excision (WLE) against British Association of Day Surgery (BADS) standards within NHS trust over a two-cycle audit, and to assess the impact of targeted service changes between cycles on the performance.
Background
BADS recommends day case rates of 75% for mastectomies and 95% for WLE within NHS trusts.
Methods
A retrospective audit of all patients undergoing mastectomy or WLE over two six‐month periods (July–December 2024 and June–November 2025) was undertaken. Data were collected from theatre booking systems and discharge summaries, supplemented by discussion with the breast specialist nurse. Outcomes included day case rate, reasons for planned and unplanned overnight stay.
Results
In 2024, 103 patients underwent surgery; 19% required admission and 80% of these were unplanned, with common reasons including clinical deterioration, late operating lists and communication issues around planned admission. Day case rates were 62% for mastectomy and 91% for WLE, below BADS targets. Following interventions (improved communication between pre‐assessment and booking teams and prioritising mastectomies early on operating lists), 2025 data demonstrated improved day case rates of 85% for mastectomy and 93% for WLE, meeting BADS standards for mastectomy. Most remaining admissions were due to patients being clinically unwell.
Conclusion
Targeted pathway changes led to a meaningful improvement in day case mastectomy rates, achieving national standards while maintaining patient safety. Residual admissions largely reflected unavoidable clinical factors, suggesting that further gains may be limited without compromising quality of care.
Authors
Sabrina Poppy Barnes, Victoria Brown
Salisbury District Hospital, Salisbury, United Kingdom