Increase in outpatient mastectomies

My BMX was also scheduled outpatient...i did ask my BS for 1 overnight which was fine...But wasn't ready to go home in 24 hours and asked for another night......

They approved but it took all day and I was exhausted from fear....I knew i wasn't ready.

This is a very important subject

Thank You for bringing up LongtermSurvivor

My unilateral MX was a day surgery. Hindsight, I definitely should have stayed overnight. I've had several surgeries throughout my life, so I do have a little experience under my belt so to speak.

Thank goodness mandatory “drive-thru mastectomy” was outlawed in IL. Many times, though, even an overnight stay is coded as “observational hold” rather than a full admission so that your insurance is likelier to pay for it--but if on Medicare it is covered only under Part B (requiring a co-pay for those w/o a supplement) rather than the free Part A which covers formal hospital admissions.

Mine was a drive-thru. Pretty much, at my hospital (I work there) they are all drive-thru's,, unless you are getting recon at the same time,, or older with underlying medical issues.

I was so ready to leave the hospital eight hours post surgery. But I had a very standard mx with SND only. I think we may be comparing oranges to apples here.

I'm with ksusan. One of my main goals going into surgery was to be able to go home to my kids that day, so as I woke up I started concentrating on the things I needed to do (pee, drink, eat). I would have felt even more helpless if I hadn't been able to have some say in that decision. There has to be a happy medium somewhere between making things illegal and insurance dictating our care so it can be as cheap as possbile.

ChiSandy, I wasn't referring to your posts specifically. I was referring to comments that are blanket condemnations of the possibility of outpatient surgery that use words like "barbaric" (on BCA's Facebook post) when for some people it's a reasonable, and preferable, option. I agree insurers shouldn't be allowed to dictate level of care as a blanket policy. I would be concerned if people were being made to stay in the hospital against their wishes for non-medical reasons, too.

Things have definitely changed over the years. In 1983, I suffered what was misleadingly termed an “incomplete abortion,” which was really a first-trimester miscarriage of what turned out to have been a blighted ovum--I bled for a couple of days but failed to fully expel the “products of conception” (they said it was genetically inadequate to be called a fetus or even an embryo). I had gone to the OB-GYN, who immediately had me wheeled across the street to be admitted overnight for a D&C the next day. (I wasn’t even given the option to go home and pack a nightgown & fresh clothes--my husband & friends had to bring them to me). And they kept me in overnight after the procedure too, discharging me only when they were sure I was stable enough to go home. The very next year, when I birthed Gordy via C-section, I was kept in for a week.

But in 1994 I had a laparoscopic cholecystectomy (aka "adios, gallbladder”). I checked in early in the morning, had the surgery (during which they couldn’t retrieve a stone that had popped loose into the common bile duct) and so I stayed in overnight. When by the next day I still hadn’t farted or pooped and was still in pain, I wanted to stay another night--Bob said standard policy after an abdominal surgery is to not discharge a patient until they’ve passed gas and are on at least soft solid foods. I actually had to get prior auth. from my insurer for that, and it took quite a bit of arguing (and playing the “I’m a lawyer married to a doctor” veiled-threat card). Why the difference? Well, 10 yrs. earlier we were members of Anchor, a closed-panel HMO which was owned and run by the Rush health system and its physicians. I incurred no charges for my ’83 & ’84 admissions except for phone & TV. But by ’94, Anchor had been sold several times, dissolved and I was now on Unicare/Wellpoint--unaffiliated with Rush-Pres. St. Luke’s hospital. Thus, the insurer and hospital were two separate, unrelated, and possibly adversarial entities.

Two years later, while crossing a street I was hit by a car, necessitating open reduction/internal fixation surgery with bone autograft in order to save my leg. I had to wait a day after being admitted for the surgery (a 7-hr procedure, which kept getting pushed back until the surgeon decided he’d need to wait till the next day in order to devote enough time and energy to it). Two days after surgery, still on the PCR pump and having just had the urinary catheter pulled, I was informed I was being discharged to home--even though I was to be non-weight-bearing for at least 8 weeks, would need twice-daily physical & occupational therapy, and my house had stairs from the street to the first floor. Once again, we had to raise a stink to get me into inpatient rehab for a couple of weeks--I might have lost the argument but for the fact that they’d have had to pay more for medi-car wheelchair-accessible transport and an escort than for a rehab bed. It goes without saying that as soon thereafter as we could switch to United’s top-level PPO, we did. After each of my knee replacements 16 & 17 years after that, United didn’t even blink at 2 weeks in a topnotch rehab facility.

United’s farewell gift to me was my bc imaging, biopsy, surgery & rads. There were copays, but not outrageous. And it was made clear to me that if my lumpectomy was done later in the day, or I developed severe pain or another complication, I would have been admitted overnight. As it was, I was able to go home the same day. I’m on Medicare now--they’re more careful now and tend to err on the side of caution. (For Bob’s four admissions and two surgeries last year, we owed not a penny).

I think TB90 has a point about apples and oranges. I've read many times that a BMX without reconstruction is generally far less painful than getting TEs (or, of course, more complicated recon) at the same time. I was very glad to have the IV for pain meds the first night after surgery. I'm pretty tough but there was considerable pain. I also think it's nice for everyone to have the option to stay in case of complications.

It's interesting how standards have changed over time. ChiSandy, you say you were in the hospital for a week after a c-section in 1984? I had a c-section in 1991 (unplanned, in the afternoon) and was required to check out the next morning, even though they were keeping my baby in for observation. I slept in their complimentary "mother's room" the second night in order to be near my baby. I think the standards have loosened up again for c-sections, thankfully.

Wouldn't a law making coverage for 48 hours just make the insurance companies cover that, IF that's what the doctor and patient wanted (not make it mandatory)? I don't think they would complain if both doctor and patient signed off on early discharge, as it would save them money. On the other hand, not requiring coverage allows some patients to be rushed out before they are ready. So I definitely think there should be a national law requiring coverage for 48 hrs.

I'm not sure about bilateral mastectomies but if having one breast off the standard hospital stay is 3 nights here in Australia.

I had my surgery on a Friday afternoon and was discharged on Monday morning. While I was ready to come home on the Monday I felt it was a good amount of time. My pain was controlled, I was moving around well, managing showers without assistance. It also gave me the opportunity to see the Physiotherapist twice and to get started on some exercises.

Makes me thankful that we don't have to "battle" with insurance companies. I have had very few out of pocket expenses. Almost everything has been covered by the public health care system.