Alexei S Mlodinow1, Jon P Ver Halen, Seokchun Lim, Seokchum Lim, Khang T Nguyen, Jessica A Gaido, John Y S Kim. 1. From the *Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL; †Department of Plastic Surgery, University of Tennessee Health Science Center, Memphis, TN; and ‡Rosalind Franklin University of Medicine and Science, Chicago Medical School, North Chicago, IL.
Abstract
BACKGROUND: Recent health care legislation institutes penalties for surgical readmissions secondary to complications. There is a paucity of evidence describing risk factors for readmission after breast reconstruction procedures. METHODS: Patients undergoing breast reconstruction in 2011 were identified in the National Surgical Quality Improvement Program database. Patients were grouped as purely immediate implant/tissue-expander reconstructions or purely autologous reconstruction for analysis. Reconstructions involving multiple types of procedures were excluded due to difficulty with classification. Perioperative variables were analyzed using χ and Student t test as appropriate. Multivariate regression modeling was used to identify risk factors for readmission. RESULTS: Of 5012 patients meeting inclusion criteria, 3960 and 1052 underwent implant/expander and autologous reconstructions, respectively. Implant/expander and autologous cohorts experienced similar readmission rates (4.34% vs 5.32%, respectively; P = 0.18). However, autologous reconstructions experienced a higher rate of overall complications than implant/expander reconstructions (19.96% vs 5.86%, respectively; P < 0.05), as well as higher rates of reoperation (9.7% vs 6.5%, respectively; P < 0.05). Common predictors of readmission for implant/expander and autologous cohorts included operative time, American Society of Anesthesiologist class 3 and 4, and superficial surgical site infection. Smoking, sepsis, deep wound infection, organ space infection, and wound disruption were predictive of readmission for implant/expander reconstruction only, whereas hypertension was predictive of readmission after autologous reconstruction only. CONCLUSIONS: This is the first study of readmission rates after breast reconstruction. Knowledge of specific risk factors for readmission may improve patient outcomes, steer strategies for optimizing reconstructive outcomes, and minimize readmissions.
BACKGROUND: Recent health care legislation institutes penalties for surgical readmissions secondary to complications. There is a paucity of evidence describing risk factors for readmission after breast reconstruction procedures. METHODS:Patients undergoing breast reconstruction in 2011 were identified in the National Surgical Quality Improvement Program database. Patients were grouped as purely immediate implant/tissue-expander reconstructions or purely autologous reconstruction for analysis. Reconstructions involving multiple types of procedures were excluded due to difficulty with classification. Perioperative variables were analyzed using χ and Student t test as appropriate. Multivariate regression modeling was used to identify risk factors for readmission. RESULTS: Of 5012 patients meeting inclusion criteria, 3960 and 1052 underwent implant/expander and autologous reconstructions, respectively. Implant/expander and autologous cohorts experienced similar readmission rates (4.34% vs 5.32%, respectively; P = 0.18). However, autologous reconstructions experienced a higher rate of overall complications than implant/expander reconstructions (19.96% vs 5.86%, respectively; P < 0.05), as well as higher rates of reoperation (9.7% vs 6.5%, respectively; P < 0.05). Common predictors of readmission for implant/expander and autologous cohorts included operative time, American Society of Anesthesiologist class 3 and 4, and superficial surgical site infection. Smoking, sepsis, deep wound infection, organ space infection, and wound disruption were predictive of readmission for implant/expander reconstruction only, whereas hypertension was predictive of readmission after autologous reconstruction only. CONCLUSIONS: This is the first study of readmission rates after breast reconstruction. Knowledge of specific risk factors for readmission may improve patient outcomes, steer strategies for optimizing reconstructive outcomes, and minimize readmissions.
Authors: Kathleen B Cartmell; Mary Dooley; Martina Mueller; Georges J Nahhas; Clara E Dismuke; Graham W Warren; Vince Talbot; K Michael Cummings Journal: Med Care Date: 2018-04 Impact factor: 2.983
Authors: John Y S Kim; Alexei S Mlodinow; Nima Khavanin; Keith M Hume; Christopher J Simmons; Michael J Weiss; Robert X Murphy; Karol A Gutowski Journal: Plast Reconstr Surg Glob Open Date: 2015-06-05
Authors: Kathleen B Cartmell; Clara E Dismuke; Mary Dooley; Martina Mueller; Georges J Nahhas; Graham W Warren; Peter Fallis; K Michael Cummings Journal: Med Care Date: 2018-10 Impact factor: 2.983