A randomized trial explores whether going home the same day is as safe and effective as staying overnight after immediate implant-based breast reconstruction.
Interview by Alyx Arnett
Same-day discharge after immediate implant-based breast reconstruction has gained traction as enhanced recovery after surgery (ERAS) protocols have become more widely adopted. Although retrospective studies have suggested the approach is safe, prospective evidence comparing same-day discharge with an overnight stay has been limited.
To address that gap, researchers conducted a randomized controlled trial of patients undergoing immediate implant-based breast reconstruction following mastectomy. The study found no significant differences in complications, pain, opioid use, emergency department visits, or patient-reported outcomes between patients discharged the day of surgery and those discharged the following day.
“Taken together, these results support that same-day discharge is a safe and feasible option for appropriately selected patients within a structured ERAS pathway,” says study author Christodoulos Kaoutzanis, MD, director of breast reconstruction in the Division of Plastic & Reconstructive Surgery at University of Colorado Anschutz. “This is particularly meaningful because it is the first randomized, rather than retrospective, evidence on this specific question.”
In this Research Q&A, Kaoutzanis and coauthor Michael Gehring, MD, discuss the study’s findings and what they could mean for patient selection and the broader adoption of same-day discharge after implant-based breast reconstruction.
[Editor’s note: Read the article “Comparing discharge timing in patients undergoing immediate implant-based breast reconstruction: A randomized controlled trial,” in Plastic and Reconstructive Surgery]
PSP: What prompted your team to investigate whether patients undergoing immediate implant-based breast reconstruction should be discharged the same day versus the following day?
Kaoutzanis: Implant-based reconstruction rates have been rising steadily, with implant-based approaches increasing roughly 11% per year. At the same time, ERAS protocols have become common in this population, and the COVID-19 pandemic accelerated interest in same-day discharge as hospitals limited non-emergent overnight stays.
Despite that shift, the existing literature supporting same-day discharge was almost entirely retrospective or database-based, and none of it had specifically captured patient-reported outcomes or patient perceptions of their discharge timing. We wanted to fill that gap with a prospective, randomized comparison.
PSP: Can you describe the two patient groups that were compared and the outcomes you evaluated to determine whether one discharge strategy was better than the other?
Kaoutzanis: We enrolled 121 patients (217 reconstructed breasts) undergoing immediate implant-based reconstruction after mastectomy, all cared for under the same ERAS protocol. Patients were randomized to discharge either the day of surgery (POD 0) or the following day (POD 1), stratified by whether they were having unilateral or bilateral surgery.
Our primary outcomes were 30-day surgical complications and systemic complications, emergency room visits, readmissions, and reoperations. Secondary outcomes included pain scores, opioid consumption, validated quality-of-recovery surveys, validated patient-reported outcome surveys, and open-ended questions about how patients felt about their discharge timing.
PSP: What were the key findings?
Gehring: There were no statistically significant differences between the POD 0 and POD 1 groups in 30-day complications, emergency room visits, readmissions, or reoperations. Pain scores and opioid consumption were essentially identical between the two groups by postoperative day 7.
Most patient-reported outcome differences that appeared at baseline or early follow-up disappeared after adjusting for confounders. Both groups reported high satisfaction with their discharge timing—95% of POD 0 patients and 92% of POD 1 patients felt their discharge timing was appropriate.
PSP: Was there anything in the results that surprised you?
Kaoutzanis: The overall safety findings were consistent with what smaller, retrospective studies had already suggested, so those were not surprising. What was more interesting was on the patient-reported outcomes side; after adjustment, the POD 0 group actually reported slightly worse physical function and more sleep disturbance at postoperative day 7 than the POD 1 group, despite most patients citing “being in their own bed” as a top advantage of going home the same day. That is a bit counterintuitive, though it should be noted the score differences were small and likely not clinically meaningful.
PSP: What characteristics make a patient a good candidate for same-day discharge, and when is an overnight stay still the better option?
Kaoutzanis: The trial excluded patients 80 years or older and those with an ASA Physical Status Classification of 4 or higher, which gives a reasonable starting framework that younger, healthier patients with well-controlled comorbidities and reliable support at home tend to be the best candidates. Patients who value being in their own environment and have accessible follow-up care also seem to do well with same-day discharge.
Conversely, patients with more complex comorbidities, those without reliable home support, or those who as some in our POD 1 cohort noted value having medical staff readily available to answer questions overnight, may be better served by staying an extra night. This is somewhat beyond what the trial itself directly tested, since it was not designed to identify subgroup predictors, so this reflects clinical judgment as much as the data itself.
PSP: If a practice is interested in implementing or expanding same-day discharge after immediate implant-based breast reconstruction, what protocols need to be in place to do so safely?
Kaoutzanis: A structured ERAS protocol is the foundation of our results and as such our results only apply within that context, since all patients in the trial (both POD 0 and POD 1) received ERAS care. Beyond that, practices should have clear discharge criteria, reliable mechanisms for postoperative pain control and drain management education, a way to reach patients quickly if concerns arise at home (phone triage or similar mechanism), and a low threshold for bringing patients back in for evaluation if needed.
Adequate preoperative counseling also matters, helping patients understand what to expect and manage at home (drains, medications), and was one of the more commonly cited concerns among our same-day discharge patients.
PSP: What additional research is needed before same-day discharge becomes more widely adopted?
Kaoutzanis: We think this trial adds meaningful support for same-day discharge, but there are real limits to how far it generalizes. It was conducted at two hospitals using one institution’s specific ERAS protocol, and protocols vary meaningfully across institutions. So replication in other settings and with more diverse patient populations would help confirm generalizability.
Complications were also only captured within 30 days at the study hospitals, so anything managed elsewhere or beyond that window would not have been captured. Larger, multi-institutional trials and further work identifying which specific patient subgroups benefit most from same-day versus overnight discharge would help move this toward broader, more confident implementation.
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