Predictors of Readmission After Breast Reconstruction

Mlodinow, Alexei S.; Halen, Jon P. Ver; Lim, Seokchum; Nguyen, Khang T.; Gaido, Jessica; Kim, John Y.S.

doi:10.1097/sap.0b013e3182a0df25

Cited by 46 publications

(20 citation statements)

References 38 publications

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“…In contrast to previous studies, we found no associations between age, BMI, or duration of operation and SSI rates [1,2,7,15,21,36]. Our SSI rate, of 4.5%, was also relatively low.…”

Section: Discussioncontrasting

confidence: 99%

“…Most hospital readmissions after surgery are due to SSI [1]. With the recent focus on readmission rates as an indicator of quality of care, to minimize the risk of patient readmission after surgery is imperative [43].…”

Section: Discussionmentioning

confidence: 99%

“…Owing to its numerous and varied psychosocial benefits, breast reconstruction is currently considered to be an integral part of breast cancer treatment [1]. However, surgical site infection (SSI) is a major cause of postoperative morbidity after breast reconstruction.…”

Section: Introductionmentioning

confidence: 99%

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Dressing Wear Time after Breast Reconstruction: A Randomized Clinical Trial

et al. 2016

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BackgroundThe evidence to support dressing standards for breast surgery wounds is empiric and scarce.ObjectiveThis two-arm randomized clinical trial was designed to assess the effect of dressing wear time on surgical site infection (SSI) rates, skin colonization and patient perceptions.MethodsA total of 200 breast cancer patients undergoing breast reconstruction were prospectively enrolled. Patients were randomly allocated to group I (dressing removed on the first postoperative day, n = 100) or group II (dressing removed on the sixth postoperative day, n = 100). SSIs were defined and classified according to criteria from the Centers for Disease Control and Prevention. Samples collected before placing the dressing and after 1 day (group I) and 6 days (both groups) were cultured for skin colonization assessments. Patients preferences and perceptions with regard to safety, comfort and convenience were recorded and analyzed.ResultsA total of 186 patients completed the follow-up. The global SSI rate was 4.5%. Six patients in group I and three in group II had SSI (p = 0.497). Before dressing, the groups were similar with regard to skin colonization. At the sixth day, there was a higher colonization by coagulase-negative staphylococci in group I (p<0.0001). Patients preferred to keep dressing for six days (p<0.0001), and considered this a safer choice (p<0.05).ConclusionsDespite group I had a higher skin colonization by coagulase-negative staphylococci on the sixth postoperative day, there was no difference in SSI rates. Patients preferred keeping dressing for six days and considered it a safer choice.Trial RegistrationClinicalTrials.gov NCT01148823

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“…In contrast to previous studies, we found no associations between age, BMI, or duration of operation and SSI rates [1,2,7,15,21,36]. Our SSI rate, of 4.5%, was also relatively low.…”

Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Dressing Wear Time after Breast Reconstruction: A Randomized Clinical Trial

et al. 2016

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“…Our understanding of ADM remodeling in prosthetic breast reconstruction is derived from clinical experience 54, 55 , translational animal models 53, 56–58 , and extrapolation from the hernia literature 48, 59 . Remodeling of an ADM sandwiched between well-vascularized surfaces 60–62 is expected to be more robust than around a prosthesis.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Chemotherapy and Radiation Therapy on the Remodeling of Acellular Dermal Matrices in Staged, Prosthetic Breast Reconstruction

Myckatyn

Cavallo

Sharma

et al. 2015

Plastic and Reconstructive Surgery

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Background An acellular dermal matrix (ADM) used in prosthetic breast reconstruction will typically incorporate, in time, with the overlying mastectomy skin flap. This remodeling process may be adversely impacted in patients that require chemotherapy and radiation therapies that influence neovascularization and cellular proliferation. Methods Multiple biopsies of the submuscular capsule and ADM were procured from 86 women (N=94 breasts) undergoing exchange of a tissue expander for a breast implant. These were divided by biopsy location : submuscular capsule (control) as well as superiorly, centrally and inferiorly along the ADM. Specimens were assessed grossly for incorporation and semi-quantitatively for cellular infiltration, cell type, fibrous encapsulation, scaffold degradation, extracellular matrix deposition, neovascularization, mean composite remodeling score, as well as Type I and III collagen area and ratio. Five oncologic treatment groups were compared : no adjuvant therapy (untreated), neoadjuvant chemotherapy ± radiation ; and chemotherapy ± radiation. Results ADM and submuscular capsule biopsies were procured 45 to 1805 days after ADM insertion and demonstrated a significant reduction in Type I collagen over time. Chemotherapy adversely impacted fibrous encapsulation relative to the untreated group (p=0.03). Chemotherapy with or without radiation adversely impacted Type I collagen area (p=0.02), cellular infiltration (p<0.01), extracellular matrix deposition (p<0.04), and neovascularization (p<0.01). Radiation exacerbated the adverse impact of chemotherapy for gross incorporation as well as several remodeling parameters. Neoadjuvant chemotherapy also caused a reduction in Type I (p=0.01) and III collagen (p=0.05), extracellular matrix deposition (p=0.03), and scaffold degradation (p=0.02). Conclusions Chemotherapy and radiation therapy limit ADM remodeling.

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“…Past research on the association between smoking status and readmission rates has produced equivocal results. [26][27][28][29][30][31][32][33][34] Many studies have examined commonly collected demographic variables. It has been reported that increasing age could potentially serve as a predictor of all-cause hospital readmissions, especially in patients over the age of 65.…”

Section: Discussionmentioning

confidence: 99%

Risk predictors for hospital readmission in a low socio-economic and underserved population

Couch

Peterson

Bowden

et al. 2018

JHA

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Objective: Hospital readmissions are significant and potentially preventable sources of healthcare cost in the United States. The Affordable Care Act (ACA) establishes the Hospital Readmissions Reduction Program (HRRP) in an attempt to reduce readmissions by penalizing institutions whose 30-day readmission rates are above the national average. The current study examines demographic and clinical variables associated with early hospital readmission in a low socioeconomic status, underserved population. Methods: A secondary data analysis was conducted of 2,536 patients from the acute primary care facilities who were hospitalized. Age, sex, race, ethnicity, smoking status, systolic blood pressure, diastolic blood pressure, body temperature, pulse rate, and days to follow up visit were analyzed in a sample of 2,536 hospitalized patients at or below 200% of federal poverty guidelines in Central Texas to determine association with risk of 0-30-(30), 31-60-(60) and 61-90-(90) day all-cause readmission. Results: Multinomial statistical analysis found pulse rate was associated with 30-, 60-, and 90-day readmission as compared to a control group. Days to follow-up were associated with decreased risk of readmission in all groups, and passive smoking status was associated with decreased risk of 90-day readmission as compared to a control group. Conclusions: Results offer healthcare providers with tools for potentially identifying patients at elevated risk for readmission in a disadvantaged population and suggest further investigation of other clinical and laboratory variables as predictors of readmission risk.

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Predictors of Readmission After Breast Reconstruction

Abstract: 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.

Cited by 46 publications

References 38 publications

Dressing Wear Time after Breast Reconstruction: A Randomized Clinical Trial

Dressing Wear Time after Breast Reconstruction: A Randomized Clinical Trial

The Impact of Chemotherapy and Radiation Therapy on the Remodeling of Acellular Dermal Matrices in Staged, Prosthetic Breast Reconstruction

Risk predictors for hospital readmission in a low socio-economic and underserved population

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