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

Hdl Handle:
http://hdl.handle.net/10149/98943
Title:
Medical and psychosocial effects of early discharge after surgery for breast cancer: randomised trial
Authors:
Bonnema, J. (Jorien); van Wersch, A. (Anna); van Geel, A. N. (Albert); Pruyn, J. F. (Jean); Schmitz, P. (Paul); Paul, M. (Marinus); Wiggers, T. (Theo)
Affiliation:
University Hospital Rotterdam/Daniel den Hoed Cancer Center. Department of Surgical Oncology.
Citation:
Bonnema, J. et al. (1998) 'Medical and psychosocial effects of early discharge after surgery for breast cancer: randomised trial', British Medical Journal, 316, pp.1267-71.
Publisher:
BMJ Publishing Group
Journal:
British Medical Journal
Issue Date:
Apr-1998
URI:
http://hdl.handle.net/10149/98943
PubMed ID:
9554895
Additional Links:
http://www.bmj.com/cgi/content/abstract/316/7140/1267
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.
Type:
Article
Language:
en
Keywords:
anxiety; breast cancer; clinical trial; depression; female; hospital discharge; length of stay; patient satisfaction; postoperative; complication; social psychology
ISSN:
0959-8138
Rights:
Author can archive publisher's version/PDF. For full details see http://www.sherpa.ac.uk/romeo/ [Accessed 17/05/2010]
Citation Count:
50 [Scopus, 17/05/2010]

Full metadata record

DC FieldValue Language
dc.contributor.authorBonnema, J. (Jorien)en
dc.contributor.authorvan Wersch, A. (Anna)en
dc.contributor.authorvan Geel, A. N. (Albert)en
dc.contributor.authorPruyn, J. F. (Jean)en
dc.contributor.authorSchmitz, P. (Paul)en
dc.contributor.authorPaul, M. (Marinus)en
dc.contributor.authorWiggers, T. (Theo)en
dc.date.accessioned2010-05-17T09:09:06Z-
dc.date.available2010-05-17T09:09:06Z-
dc.date.issued1998-04-
dc.identifier.citationBritish Medical Journal; 316:1267-71.en
dc.identifier.issn0959-8138-
dc.identifier.pmid9554895-
dc.identifier.urihttp://hdl.handle.net/10149/98943-
dc.description.abstractObjective: 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.en
dc.language.isoenen
dc.publisherBMJ Publishing Groupen
dc.relation.urlhttp://www.bmj.com/cgi/content/abstract/316/7140/1267-
dc.rightsAuthor can archive publisher's version/PDF. For full details see http://www.sherpa.ac.uk/romeo/ [Accessed 17/05/2010]en
dc.subjectanxietyen
dc.subjectbreast canceren
dc.subjectclinical trialen
dc.subjectdepressionen
dc.subjectfemaleen
dc.subjecthospital dischargeen
dc.subjectlength of stayen
dc.subjectpatient satisfactionen
dc.subjectpostoperativeen
dc.subjectcomplicationen
dc.subjectsocial psychologyen
dc.titleMedical and psychosocial effects of early discharge after surgery for breast cancer: randomised trialen
dc.typeArticleen
dc.contributor.departmentUniversity Hospital Rotterdam/Daniel den Hoed Cancer Center. Department of Surgical Oncology.en
dc.identifier.journalBritish Medical Journalen
ref.citationcount50 [Scopus, 17/05/2010]en
or.citation.harvardBonnema, J. et al. (1998) 'Medical and psychosocial effects of early discharge after surgery for breast cancer: randomised trial', British Medical Journal, 316, pp.1267-71.en

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