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

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.

Predictive risk factors of complications in different breast reconstruction methods

“…Variables independently associated with complications in this study included also a history of asthma or chronic obstructive pulmonary disease. This is in line with earlier studies [16,18] with free flaps and mastectomy combined with implant or muscular flap reconstruction [17]. In those studies, a significant correlation was found between COPD/ asthma and the need for revision surgery.…”

“…There are many studies evaluating postoperative complications and comorbidities associated with breast reconstructions [11][12][13][14][15][16][17][18], but only few have assessed the predictive risk factors for postoperative complications. It is common that only one or two surgical techniques are compared to or the follow-up time is 30 days postoperatively [14,19,20].…”

“…It is common that only one or two surgical techniques are compared to or the follow-up time is 30 days postoperatively [14,19,20]. It has been concluded that traditional 30-day readmission rates are not an adequate quality metric for breast reconstruction given the number of late postoperative readmissions in breast reconstructions [11,18]. In order to describe reliable data concerning complications in breast reconstructive surgery, it is important to systematically analyze and compare complications from different reconstructive methods.…”

Racial Disparities in Outcomes of Reconstructive Breast Surgery: An Analysis of 51,362 Patients from the ACS-NSQIP

“…30,31 Second, Magno-Padron et al recently described the classic 30-day complication variable as potentially missing a significant number of late readmissions and complications using the Nationwide Readmission Database. 32 This can also contribute to underestimation of the complication rate identified in our study. Moreover, we were not able to differentiate between flap types, which is also suggested to have different complication profiles.…”

Impact of Blood Transfusion in Free Flap Breast Reconstruction Using Propensity Score Matching

“…The authors found a 4.3% wound-related readmission rate and identified several risk factors, such as hypertension, smoking, and obesity, that were associated with a higher risk of readmission. 29 In the present paper, we were able to match for these known risk factors, obliterating their impact on outcomes, and improving the strength of the analysis.…”