Extrapulmonary tuberculosis

I read, with great interest, the documented advantages and cost-effectiveness of early discharge following breast surgery.In our Caribbean setting, bed shortages and cost implications have forced us to look into early discharge for these patients.In 203 consecutive patients under going axillary clearance with either mastectomy or segmentectomy, the mean hospitalisation was 22 h (including 18 h postoperative stay).Because we have neither district nor hospital-based nursing care at home, a responsible relative (and/or the patient herself) is taught to empty and reseal the suction drain.All patients are afforded telephone contact with our surgical office.We have had 2 cases where the drain inadvertently dropped out at home -one on the 2nd and the other on the 7th postoperative day.The former required repeated aspiration as an out-patient; no patient needed re-admission.In another 2 cases, patients experienced leakage around the drain site; this only necessitated a change of dressing.In my view, not only is early discharge possible but there is little gain in keeping the patient beyond 24 h.Moreover, one can further reduce cost of home care by teaching the patient or a responsible relative how to manage the drain.