Outpatient mastectomy: ERAS® and same-day discharge as a viable option in the elderly

Background: Despite increases in same-day discharge after mastectomy, there are few studies assessing its implications in the elderly. Our institution initiated enhanced recovery after surgery (ERAS®) principles emphasizing outpatient mastectomy in 2017. This study assessed the effect of introducing outpatient mastectomy on outcomes in the elderly. Methods: A prospective database was retrospectively reviewed for patients ≥70 years old undergoing mastectomy with or without implant-based reconstruction from 2015 to 2023. Patients from 2015 to 2016 were pre-ERAS®, and 2017-2023 were post-ERAS®. Results: Out of 139 patients, 85 were post-ERAS® and 54 were pre-ERAS®. Of the post-ERAS®, 65% were outpatient versus 17% of pre-ERAS® patients (p < 0.001). Complication rates were no different between groups (33% vs 33%, p = 0.88), even when separated by type of complication, including those requiring operative intervention (14% vs 13%, p = 0.85). Conclusions: Outpatient mastectomy can be implemented in the elderly without an increase in morbidity, making it safe and practical in this population.