Research Article Adopting Ambulatory Breast Cancer Surgery as the Standard of Care in an Asian Population Yvonne Ying Ru Ng, Patrick Mun Yew Chan, Juliana Jia Chuan Chen, Melanie Dee Wern Seah, Christine Teo, and Ern Yu Tan Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433 Correspondence should be addressed to Ern Yu Tan; ern yu tan@ttsh.com.sg Received 31 May 2014; Accepted 23 July 2014; Published 12 August 2014 Academic Editor: Mahmoud B. El-Tamer Copyright © 2014 Yvonne Ying Ru Ng et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. Ambulatory surgery is not commonly practiced in Asia. A 23-hour ambulatory (AS23) service was implemented at our institute in March 2004 to allow more surgeries to be performed as ambulatory procedures. In this study, we reviewed the impact of the AS23 service on breast cancer surgeries and reviewed surgical outcomes, including postoperative complications, length of stay, and 30-day readmission. Methods. Retrospective review was performed of 1742 patients who underwent deinitive breast cancer surgery from 1 March 2004 to 31 December 2010. Results. By 2010, more than 70% of surgeries were being performed as ambulatory procedures. Younger women (P < 0.01), those undergoing wide local excision (P < 0.01) and those with ductal carcinoma-in situ or early stage breast cancer (P < 0.01), were more likely to undergo ambulatory surgery. Six percent of patients initially scheduled for ambulatory surgery were eventually managed as inpatients; a third of these were because of perioperative complications. Wound complications, 30-day readmission and reoperation rates were not more frequent with ambulatory surgery. Conclusion. Ambulatory breast cancer surgery is now the standard of care at our institute. An integrated worklow facilitating proper patient selection and structured postoperativee outpatient care have ensured minimal complications and high patient acceptance. 1. Introduction Ambulatory surgery was initially limited to procedures per- formed under local or regional anaesthesia, which required minimal postoperative monitoring. Anesthesia techniques and perioperative management have evolved ever since such that low risk surgeries performed under general anaesthesia can now also be performed in the ambulatory setting. Patients undergoing breast cancer surgery seldom develop serious complications and most return to their preoperative function soon ater the surgery, making them ideal candidates for ambulatory surgery. In spite of this, many patients have been managed in the past as inpatients due to concerns about drain care and the lack of structured outpatient follow-up care. his has gradually changed over the years. Ater sentinel lymph node biopsy (SLNB) was adopted as the standard of care, full axillary lymph nodal dissection (ALND), and consequently the use of surgical drains, became less common. his, together with the establishment of specialised breast units in many centres to provide continuity of care ater hospital discharge, has led to a greater push towards ambulatory breast cancer surgery. Early discharge has been shown to contribute to greater healthcare eiciency without compromising the quality of care. Studies have consistently airmed the safety and beneits of ambulatory surgery, even in patients discharged with surgi- cal drains in situ [1–3]. Despite this, ambulatory surgery is not as readily accepted in Asia as compared to Western countries, where there is greater emphasis on patient empowerment [4, 5]. Older women, in particular, are reluctant to be discharged home early as they perceive cancer surgery to be major surgery and believe that specialised care in a hospital setting during the postoperative period will prevent complications and even future disease relapse. In March 2004, our institute introduced a 23-hour ambulatory surgery service (AS23). he AS23 unit func- tions as an independent facility from the inpatient wards, with its own bed capacity and staf complement. Strict Hindawi Publishing Corporation International Journal of Breast Cancer Volume 2014, Article ID 672743, 8 pages http://dx.doi.org/10.1155/2014/672743