AWAKE BREAST SURGERY AND DE-ESCALATION TREATMENT: STRATEGIES FOR FRAIL AND ELDERLY BREAST CANCER PATIENTS

objective: awake breast surgery has been proven to be a concrete alternative to surgery under general anesthesia. this technique was shown to be advantageous in various aspects such as length of hospital-ization and economic sustainability. our study aims to verify the advantages of this technique in terms of operat-ing room times, length of stay, and outcome in frail patients diagnosed with breast cancer. patients and methods: our retrospective study enrolled all frail patients, ASA >= 3, diagnosed with breast cancer and scheduled to undergo a surgical intervention. the type of surgery, duration of surgery, length of hospital stay, type of anesthesia, postoperative complications, postoperative dissociative episodes and CCI (Charlson Co-morbidity Index) score were evaluated by comparing the data between the group of awake surgery and the group of patients undergoing surgery under general anesthesia. results: a total of 34 patients were enrolled; 16 patients (45.7%) undergoing awake surgery with a mean age of 78 years [75;95], and 18 patients (54.3%) receiving general anesthesia. CCI was significantly higher in the awake group with a median score of 12 [9;13] vs. 10 [9;11] in the no-awake group: relative p-value was <0.001. postop-erative complications were comparable between the groups, showing no statistically significant differences. six patients (33.3%) in the general anesthesia group experienced dissociative complications vs. 1 (6.3%) in the awake surgery group (p=0.05). there were no statistically significant differences regarding the other parameters. conclusions: PAwake breast surgery in elderly patients, especially in frail ones, could reduce the incidence of postoperative delirium by enabling a shorter hospitalization and allowing for a faster recovery.