Evaluation of prepectoral reconstruction surgical outcomes: Main operating room vs ambulatory surgery center

Introduction: During the height of the recent Coronavirus (COVID-19) pandemic, several surgeries were transitioned to ambulatory surgery centers to reserve inpatient resources and reduce transmission risks. Our study evaluated the surgical outcomes of patients who underwent prepectoral breast reconstruction in the operating rooms of two full-service main hospitals versus their associated surgery centers.

Methods: A retrospective chart review was conducted of patients who underwent immediate prepectoral breast reconstruction at a single hospital between 2018 and 2022. Eligible patients had at least 3 months of post-expander follow-up, with the majority also having 3 months of post-implant follow-up. Patient demographics, reconstructive characteristics, post-expander outcomes, and post-implant outcomes were evaluated between the surgery center and main operating room using the chi-squared (or Fisher's exact) and Wilcoxon ranked-sum tests.

Results: This study included 301 patients, outcomes of 509 post-expander breasts, and outcomes of 410 post-implant breasts. The patient characteristics were similar with the only significant difference being the hospital length of stay (increased stay at the main hospital). There were no statistically significant differences in any of the surgical outcomes between the two groups in the post-expander or post-implant period.

Conclusion: The COVID-19 pandemic disrupted elective procedures, prompting a shift toward outpatient surgery to optimize hospital resources and reduce inpatient exposure risks. Although breast reconstruction is elective, delays can pose risks for patients with cancer. Our results show that surgical outcomes for prepectoral prosthetic breast reconstruction remain consistent whether performed in outpatient surgical centers or main hospitals.