Purpose: Managed care creates pressure to perform breast reduction on an outpatient basis. General anesthesia is one factor, which contributes to the morbidity of this operation and often necessitates admission to the hospital. We compare the morbidity and outcomes of patients who have breast reductions done under general anesthesia as compared to those done under local anesthesia plus intravenous sedation, to substantiate that sedational anesthesia facilitates performing this operation on an outpatient basis.
Materials and Methods: We preformed a retrospective chart review of 200 patients who underwent breast reduction for functional and/or cosmetic purposes over the past 5 years. Subset analysis of these 200 patients identified a cohort of 17 patients operated on under local anesthesia plus IV sedation (SL). These patients were matched based on BMI, age, and amount of tissue removed to historical controls operated on under general anesthesia (GA). The outcomes compared were post operative nausea and vomiting, need for unintended hospital admission, incidence of infection, hematoma or delayed healing, operative and recovery time as well as blood loss.
Results: In comparing the two groups, none of the SL patients were converted from intent to treat as outpatient to inpatient admission. In contrast, 35% of the historical case-controls under GA with intent to treat as outpatient were converted to inpatient admissions (p=0.01 Fisher’s Exact test, one-sided). There was no vomiting in the SL group, compared to 23% vomiting in the GA group. (p=0.05, Fisher’s Exact test, one-sided) General Anesthesia Local + Sedation Unintended admission 35% 0, significant p=0.01 Nausea and Vomiting 23% 0, significant, p=0.05 OR time 190 162 EBL 183 156 Infection 29% 5%, not significant, p=0.08 Hematoma 0 0 Delayed Healing 11% 17%, not significant
Discussion: We conclude that breast reduction of any size can be accomplished safely under IV Sedation plus Local anesthesia. Furthermore, if reductions are performed under IV Sed + Local, there is a dramatic decrease in post-op nausea/vomiting, which contributes to a decrease in conversion to hospital admission for patients scheduled as outpatients, and increased patient comfort without compromising other outcome measures.
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