Risk factors associated with prolonged postoperative stay following free tissue transfer: an analysis of 2425 patients from the American College of Surgeons National Surgical Quality Improvement Program database.

BACKGROUND: Length of stay following surgical procedures has a considerable impact on healthcare resource use. This study characterizes risk factors predictive of a prolonged length of stay following free tissue transfer using the American College of Surgeons National Surgical Quality Improvement Program database.
METHODS: The 2005 to 2011 National Surgical Quality Improvement Program databases were reviewed for all identifiable free tissue transfer cases. Free tissue transfers for breast and nonbreast reconstruction were analyzed separately. Prolonged length of stay was defined as greater than the 75th percentile in each cohort group. A logistic regression model was developed for prolonged postoperative length of stay following breast and nonbreast reconstruction.
RESULTS: The authors identified 2425 patients, and 885 (36 percent) had a prolonged length of stay, determined to be greater than 5 days and greater than 13 days in the breast (577 patients) and nonbreast (308 patients) reconstruction groups, respectively. Higher American Society of Anesthesiologists class and prolonged operative time were associated with a prolonged length of stay for both groups. Declining preoperative albumin level (p < 0.0001), increasing age (p = 0.0068), history of diabetes (OR, 2.16; p = 0.0215), perioperative transfusion requirement (OR, 3.64; p = 0.0311), dependent functional status (p = 0.0101), and preoperative irradiation (OR, 4.01; p = 0.0062) were also predictors for a prolonged length of stay in the nonbreast reconstruction group.
CONCLUSIONS: This study identified key predictors of prolonged length of stay following free tissue transfer. The diverging findings between cohorts with regard to the impact of comorbidities on length of stay highlight possible avenues to improve healthcare resource use.