Variables associated with length of stay in patients undergoing mastectomy and delayed‐immediate breast reconstruction with tissue expander

Manum, Joanna S.; Veith, Jacob; Wei, Guo; Kwok, Alvin C.; Agarwal, Jayant P.

doi:10.1111/tbj.13375

Cited by 8 publications

(5 citation statements)

References 20 publications

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“…9 Several other groups have since reported their experiences with DI-ABR, either in isolation or in comparison to delayed reconstruction, with varying results. [10][11][12][13] Patients undergoing immediate autologous breast reconstruction (I-ABR) have been shown to experience less psychosocial morbidity than those who have delayed reconstruction due to elimination of the experience of a mastectomy defect. [14][15][16][17] In a previous study by our group, I-ABR had higher rates of volume loss and fat necrosis, but comparable rates of serious complications and the need for revision surgeries when compared with delayed breast reconstruction in patients undergoing PMRT.…”

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confidence: 99%

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A Comparative Analysis of Immediate and Delayed-immediate Breast Reconstruction after Postmastectomy Radiation Therapy

Christopher

Morris

Broach

et al. 2021

J Reconstr Microsurg

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Background Postmastectomy radiation therapy (PMRT) is an important component in the treatment of locally advanced breast cancer. Optimal timing of therapy in relation to autologous breast reconstruction (ABR) remains clinically debated. Herein, we comparatively analyze short- and long-term outcomes between immediate ABR (I-ABR) and delayed-immediate ABR (DI-ABR) in the setting of PMRT. Methods Adult patients undergoing ABR with PMRT were separated into cohorts based on reconstructive timeline: I-ABR or DI-ABR. The groups were propensity matched 1:1 by age, body mass index, and comorbidities. Surgical site events and long-term clinical outcomes (readmissions, reoperations, and revision procedures) were collected. Univariate analyses were completed using Pearson's chi-squared tests and Fisher's exact tests, and statistical significance was set at p < 0.05. Results One hundred and thirty-two flaps (66 in each cohort) were identified for inclusion. Patients with I-ABR were more likely to experience fat necrosis (p = 0.034) and skin necrosis (p < 0.001), require additional office visits (p < 0.001) and outpatient surgeries (p = 0.015) to manage complications, and undergo revision surgery after reconstruction (p < 0.001). DI-ABR patients, however, had a 42.4% incidence of complications following tissue expander placement prior to reconstruction, with 16.7% of patients requiring reoperation during this time. Only one patient (I-ABR) experienced flap loss due to a vascular complication. Conclusion The complications encountered in both of these groups were not prohibitive to offering either treatment. Patients should be made aware of the specific and unique risks of these reconstruction timelines and involved throughout the entire decision-making process. Plastic surgeons should continue to strive to elucidate innovative approaches that facilitate enhanced quality of life without compromising oncologic therapy.

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confidence: 99%

“…9 Several other groups have since reported their experiences with DI-ABR, either in isolation or in comparison to delayed reconstruction, with varying results. 10 11 12 13…”

mentioning

confidence: 99%

A Comparative Analysis of Immediate and Delayed-immediate Breast Reconstruction after Postmastectomy Radiation Therapy

Christopher

Morris

Broach

et al. 2021

J Reconstr Microsurg

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“…For example, depression and anxiety could be a single group for analysis in one study, and another study might have anxiety, depression, Post-Traumatic Stress Disorder (PTSD), and substance use disorder grouped together as a single entity for analysis. 8,9 This made comparing individual mental illness challenging. The differences in grouping mental illnesses could be due to variability regarding the definition of mental health.…”

Section: Resultsmentioning

confidence: 99%

“…There is variability within the literature regarding whether mental illness affects length of stay (LOS) in general surgery patients. More studies found evidence that MHD increased LOS 8,14,[17][18][19][20][21] than those that did not. 9,22,23 Notably, Paro, et al, found depressed patients had an extended LOS compared to nondepressed patients undergoing surgery for cancer resections (OR 1.41, 95% CI 1.36-1.47), although the authors did not define "extended LOS."…”

Section: Resultsmentioning

confidence: 99%

Impact of Mental Health on General Surgery Patients and Strategies to Improve Outcomes

Josephs

Shaffer

Kucera

2022

The American Surgeon™

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Mental Health Disorders (MHD) are a growing concern nationwide. The significant impact MHD have on surgical outcomes has only recently started to be understood. This literature review investigated how mental health impacts the outcomes of general surgery patients and what can be done to make improvements. Patients with schizophrenia had the poorest surgical outcomes. Mental health disorders increased post-surgical pain, hospital length of stay, complications, readmissions, and mortality. Mental health disorders decreased wound healing and quality of care. Optimizing outcomes will be best accomplished through integrating more effective perioperative screening tools and interventions. Screenings tools can incorporate artificial intelligence, MHD data, resilience and its biomarkers, and patient mental health questionnaires. Interventions include cognitive behavioral therapy, virtual reality, spirituality, pharmacology, and resilience training.

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“…Health care expenditures in the United States have increased at an unprecedented rate over the past decade 1–6. As a result, there is need to identify drivers of increased costs while improving the overall quality of patient care.…”

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confidence: 99%

Ramifications of Postoperative Dysphagia on Health Care Resource Utilization Following Elective Anterior Cervical Discectomy and Interbody Fusion for Cervical Spondylotic Myelopathy

Elsamadicy

Koo

David

et al. 2021

Clinical Spine Surgery: A Spine Publication

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The aim of this study was to investigate patient risk factors and health care resource utilization associated with postoperative dysphagia following elective anterior cervical discectomy and fusion (ACDF) for cervical spondylotic myelopathy. Summary of Background Data:There is a paucity of data on factors predisposing patients to dysphagia and the burden this complication has on health care resource utilization following ACDF.Methods: A retrospective cohort study was performed using the Nationwide Inpatient Sample (NIS) database from 2016 to 2017. All adult (above 18 y old) patients undergoing ACDF for cervical spondylotic myelopathy were identified using the ICD-10-CM diagnosis and procedural coding system. Patients were then categorized by whether they had a recorded postoperative dysphagia or no dysphagia. Weighted patient demographics, comorbidities, perioperative complications, length of hospital stay (LOS), discharge disposition, and total cost of admission were assessed. A multivariate stepwise logistic regression was used to determine both the odds ratio for risk-adjusted postoperative dysphagia as well as extended LOS.Results: A total of 17,385 patients were identified, of which 1400 (8.1%) experienced postoperative dysphagia. Compared with the No-Dysphagia cohort, the Dysphagia cohort had a greater proportion of patients experiencing a complication (P = 0.004), including 1 complication (No-Dysphagia: 2.9% vs. Dysphagia: 6.8%), and > 1 complication (No-Dysphagia: 0.3% vs. Dysphagia: 0.4%). The Dysphagia cohort experienced significantly longer hospital stays (No-Dysphagia: 1.9 ± 2.1 d vs. Dysphagia: 4.2 ± 4.3 d, P < 0.001), higher total cost of admission (No-Dysphagia: $19,441 ± 10,495 vs. Dysphagia: $25,529 ± 18,641, P < 0.001), and increased rates of nonroutine discharge (No-Dysphagia: 16.5% vs. Dysphagia: 34.3%, P < 0.001). Postoperative dysphagia was found to be a significant independent risk factor for extended LOS on multivariate analysis, with an odds ratio of 5.37 (95% confidence interval: 4.09, 7.05, P < 0.001). Conclusion:Patients experiencing postoperative dysphagia were found to have significantly longer hospital LOS, higher total cost of admission, and increased nonroutine discharge when compared with the patients who did not.

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Variables associated with length of stay in patients undergoing mastectomy and delayed‐immediate breast reconstruction with tissue expander

Cited by 8 publications

References 20 publications

A Comparative Analysis of Immediate and Delayed-immediate Breast Reconstruction after Postmastectomy Radiation Therapy

A Comparative Analysis of Immediate and Delayed-immediate Breast Reconstruction after Postmastectomy Radiation Therapy

Impact of Mental Health on General Surgery Patients and Strategies to Improve Outcomes

Ramifications of Postoperative Dysphagia on Health Care Resource Utilization Following Elective Anterior Cervical Discectomy and Interbody Fusion for Cervical Spondylotic Myelopathy

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