Sumbul Naz
Introduction
The British Association of Day Surgery (BADS) increased its day case mastectomy key performance indicator from 50% to 75% by 2024. This completed audit cycle evaluated compliance with the revised standard and the safety and sustainability of pathway changes in an NHS breast unit.
Methods
A retrospective audit was undertaken over six months (July–December 2024), followed by a six‐month re‐audit (March–August 2025). Seventy elective mastectomy patients were included (33 audit, 37 re‐audit), with a BADS 2024 standard. Following the initial audit, targeted interventions were introduced, including pathway optimization and peri‐operative practice modifications. Categorical variables were analyzed using chi‐square or Fisher’s exact tests, continuous variables with Mann‐Whitney U tests, and multivariable logistic regression identified independent predictors of same day discharge.
Results
Same day discharge rose from 12.1% (4/33) to 81.1% (30/37) (χ²=33.21, p<0.001), with a significant reduction in length of stay (p<0.001). The re‐audit cohort comprised older patients, higher BMI, more ASA III–IV cases (13 vs 5), male patients, and more complex procedures including immediate reconstruction (n=8). Readmission rates were 3.0% vs 13.9% (p=0.020), and complication rates 24.2% vs 10.8% (p=0.205) in audit and re‐audit cohorts, respectively. On multivariable analysis, the re‐audit period was independently associated with higher odds of same day discharge (OR 52.9, 95% CI 7.23–387.21, p<0.001).
Conclusions
Targeted, low‐cost pathway changes delivered a substantial, statistically significant increase in day case mastectomy rates, exceeding BADS standards even in older, more complex population.
Authors
Sumbul Naz, Jane Hornsby, Amir Bhatti, Abby Russell, Lucy Bookless
County Durham and Darlington NHS Foundation trust, Darlington, United Kingdom