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J Reconstr Microsurg 2020; 36(06): 450-457
DOI: 10.1055/s-0040-1702175
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A Nationwide Analysis of Early and Late Readmissions following Free Tissue Transfer for Breast Reconstruction

David Alejandro Magno-Padron
1   Department of Plastic Surgery, University of Utah School of Medicine, Salt Lake City, Utah
,
Willem Collier
2   Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah
,
Jaewhan Kim
3   Department of Family and Preventative Medicine, University of Utah School of Medicine, Salt Lake City, Utah
,
Jayant P. Agarwal
1   Department of Plastic Surgery, University of Utah School of Medicine, Salt Lake City, Utah
,
Alvin C. Kwok
1   Department of Plastic Surgery, University of Utah School of Medicine, Salt Lake City, Utah
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Publikationsverlauf

13. September 2019

05. Januar 2020

Publikationsdatum:
15. März 2020 (online)

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Abstract

Background Traditionally, surgical quality outcomes are assessed using a 30-day postoperative window. For breast cancer patients undergoing free tissue transfer for breast reconstruction, we sought to describe the distribution of and specific risk factors for early and late readmissions within a 0- to 90-day postoperative period.

Patients and Methods The Nationwide Readmissions Database was used to conduct a retrospective cohort study. Breast cancer patients undergoing free tissue transfer for breast reconstruction were identified using International Classification of Diseases -9 diagnosis and procedure codes. Ninety-day readmissions related to infection or wound complications were identified. Univariable and multivariable logistic regression models were used to identify patient risk factors for readmissions that occurred early (0–30 days) and late (31–90 days) after their index procedure.

Results In the weighted sample, we identified approximately 7,305 free flap breast reconstructions and a surgical wound-related readmission rate of 4.3% (n = 312): 65.4% of the readmissions occurred early while 34.6% occurred late after surgery. The mean days to readmission was 26, and 75% of all readmissions occurred within the first 36 days after surgery. Variables independently associated with readmissions during the 0- to 90-day postoperative period included: history of chronic obstructive pulmonary disease (p = 0.036), hypertension (p = 0.03), obesity (p ≤ 0.001), and history of smoking (p = 0.004). The variables independently associated with the early readmission period were the same as those identified for the 0- to 90-day postoperative period. The variables independently associated with late readmissions were different: history of depression (p = 0.001) and history of smoking (p = 0.001).

Conclusion The conventional 30-day hospital readmission rate classically used as a quality metric is overlooking a significant portion of admissions after free flap-based breast reconstruction. Different variables were found to be associated with readmission in the early versus late cohorts. Interventions targeting these variables could decrease readmissions and their associated costs.

Keywords

autologous breast reconstruction - readmission - free-flap

Supplementary Material

 

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