Autologous Breast Reconstruction is Associated with Lower 90-day Readmission Rates

Abstract

Background: Breast reconstruction is associated with improved quality of life after mastectomy. Options for breast reconstruction include autologous and implant-based methods. Although autologous reconstruction is more technically challenging and requires longer operative time, it is thought of as the gold standard. Our study examined differences in 90-day readmission rates between implant-based and autologous breast reconstruction using discharge data from the National Readmission Database, Healthcare Cost and Utilization Project, and Agency for Healthcare Research and Quality. Methods: The National Readmission Database was used to identify patients undergoing postmastectomy breast reconstruction. Patients were selected using ICD-10 PCS codes linked to autologous and implant-based reconstruction. Ninety-day readmission rates were determined. After matching the two groups on a 1:1 basis for baseline comorbidities and demographics, a multivariable logistic regression analysis was performed to variables associated with higher readmission rates. Results: The leading diagnoses associated with readmissions were infectious and pulmonary. After one to one matching, autologous breast reconstruction, private insurance versus Medicaid, and income quartile 4 versus 1 were all less likely to be readmitted within 90 days of discharge. Patients with a high Charlson index and those with a longer length of initial hospital stay are significantly more likely to be readmitted within 90 days. Conclusions: Patients undergoing autologous breast reconstruction were 23% less likely to be readmitted within 90 days from discharge. Fewer comorbidities, shorter length of hospital stay, and higher socioeconomic status are also associated with lower readmission rates following breast reconstruction.

Predictors of 30-day Hospital Readmission after Autologous vs. Implant-based Breast Reconstruction: A 16-year Analysis of 175,474 Patients

“…Literature is inconclusive regarding the impact of reconstructive type on readmission rates. A recent study using the National Readmission Database found that patients undergoing AR were 23% less likely to be readmitted within 90 days after discharge than those who underwent IBR, whereas another metaanalysis reported comparable risks of unplanned HR 13,14) . This incongruence suggests that patient comorbidities, surgical techniques, and postoperative care may have a higher impact on readmission rates than procedure type.…”

The Impact of Prior Breast Augmentation on Breast Reconstruction after Mastectomy

“…16 Other studies have corroborated these findings, with approximately 40% of patients undergoing mastectomy, the rate of risk-reducing bilateral mastectomies increasing, and increased rates of PMR. 17–20…”

“…16 Other studies have corroborated these findings, with approximately 40% of patients undergoing mastectomy, the rate of risk-reducing bilateral mastectomies increasing, and increased rates of PMR. [17][18][19][20] Among the augmented patients, 80% underwent PMR. This was significantly higher than 49.9% of the nonaugmented group and demonstrates that patients who have undergone previous augmentation mammaplasty may be more likely to be interested in, or be able to undergo, postmastectomy breast reconstruction.…”

“…14,15 The rate of overall breast reconstruction has increased, along with immediate breast reconstruction, and use of breast implants in general. [16][17][18][19][20] Despite the increasing rates of augmentation mammaplasties and overall breast reconstruction after mastectomy being performed, there is limited literature on the trends and outcomes of reconstruction in patients with previous augmentations. Previous studies examining the impact that breast augmentation has on breast cancer management and reconstruction have focused on the types of surgical resection, timing of reconstruction, and complication rates.…”

Does Fitzpatrick Score Predict Flap Loss? Microsurgical Breast Reconstruction Outcomes of Varying Skin Color

“…The superior aesthetic outcome is mirrored by higher rates of overall patient-reported satisfaction when compared with implants. 1,2 In addition to technical advances in donor site selection, which have broadened the range of body types reconstructive surgeons can care for, changes in legislature have eroded substantial cost barriers, allowing more women to pursue life-changing treatment. 3 Despite the efforts of public health policymakers, the steady rise in reconstruction rates has not been proportional across races, begetting an unfortunate disparity.…”