Breast Surgery as Day Surgery
Chaired by Dr Anna Lipp President The British Association of Day Surgery & Jo Marsden Consultant Breast Surgeon King’s College Hospital NHS Foundation Trust, today's conference withh enable delegates to develop a day case management pathway for patients requiring breast surgery. The basic elements of a day surgery pathway are being presented including the evaluation of the quality of care provided.
Dr Anna Lipp opens the conference with a presentation on The day surgery pathway, focusing on:
• Referral pathways
• Patient suitability
• On the day of surgery
Dr Lipp talked through the day surgery patient pathway, on discharge she said nurse led discharge is definitely the way to go for day surgery. Just need to be clear on criteria a patient has to reach in order to be discharged. Dr Lipp said that it's not always necessary for 24hour care at home after surgery it depends on the surgery and risk of complications, the patients circumstances, and availability of support if needed, and there must be 24 hours access to skilled advice.
In summary Dr Lipp said it's very important to plan the pathway all the way through, to plan pre-assessment at a time and place convenient and appropriate for the patient, to have planned nurse led discharge in place and to ensure appropriate analgesia and advice on its use available for all patients at time of discharge.
Following Dr Lipp is Mary Stocker President -Elect BADS and Consultant Anaesthetist Torbay, who looks at Evaluating performance in day surgery, discussing:
• Measuring quality in day surgery
• Evaluating the pathway
• Measuring outcomes
Jo Marsden will ask 'Why offer same day discharge for non-reconstructive breast cancer surgery?' and will discuss:
• Why was surgical practice changed?
• What is the current state of play for same day discharge?
• Why is there variation in surgical practice?
Physiotherapy management of the Breast Cancer patient - From Pre-habilitation through to Survivorship
Kat Tunnicliffe Senior Physiotherapist King’s College Hospital NHS Foundation Trust
• Physical side effects of treatment for breast cancer
• KCH Specialist Breast Physiotherapy Service
• Key physical management guidelines in absence of a specialist breast physiotherapy service
Kat discussed how the physiotherapy needs of breast surgery day surgery patients are met within her organisation. She said exercises are discussed pre-operatively with patients educated on the importance, and followed-up by telephone post-operatively with patients being invited back for group physiotherapy sessions. Kat said if there isn't a physiotherapist it's important that the multidisciplinary team promote exercise and physical activity and are able to address concerns.
Full presentation including summary of key points, resources and guidelines
Breast and axillary surgery and adjuvant treatments have a significant impact of the musculoskeletal, lymphatic and biopsychosocial systems at various points along the patient’s treatment pathway and for several years thereafter.
These are often due to the lengthy soft tissue and scar remodelling times, bony or myofascial and lymphatic dysfunctions as a consequence of treatments as well as other complications such as reduced physical activity, pain inhibition, fear avoidance and return to work issues.
Physiotherapy aims to restore function, improve fitness, aid return to work and improve or maintain consequences of treatment. There are specialist treatment and manual techniques for Breast Cancer patients, however a significant proportion of patients can be seen within a musculoskeletal setting should a dedicated specialist service be unavailable.
Exercise and Physical Activity should be considered to be the fourth treatment modality for patients with Breast Cancer and is a central part for all of my patients at various points along their pathway. At our end of treatment Health & Wellbeing event exercise is encouraged to aid the transition into survivorship / self-management as part of minimising risk of recurrence.
Today’s presentation aims to summarise the physical consequences of treatment for Breast Cancer, the role of the Specialist Breast Physiotherapy service, and guidelines of streamlining referral to physiotherapy in absence of this.
19 May 2016