Abstract: Predictors Of Readmission After Outpatient Plastic Surgery (Plastic Surgery 2013)

Sunday, October 13, 2013: 1:20 PM

Lauren M Mioton, BS , Vanderbilt School of Medicine, Nashville, TN

Donald W Buck, MD , Department of Plastic and Reconstructive Surgery, Northwestern University, Chicago, IL

Aksharananda Rambachan, BA , Department of Plastic and Reconstructive Surgery, Northwestern University, Chicago, IL

Jon P Ver Halen, MD , Department of Plastic and Reconstructive Surgery, University of Tennessee, Germantown, TN

Neil A Fine, MD , Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL

Gregory A Dumanian, MD , Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL

John YS Kim, MD , Department of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL

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Background: In October 2012, the Obama administration instituted the Hospital Readmissions Reduction Program, which deducts up to 1% of total hospital Medicare reimbursement for elevated readmission rates [1-3]. It is expected this will be extrapolated to outpatient surgical procedures in the near future. However, no comparative multi-institutional data on plastic surgery outpatient readmission rates currently exist.

Objective: We endeavored to investigate hospital readmission rates and predictors of readmission following outpatient plastic surgery.

Methods: The 2011 National Surgical Quality Improvement Program (NSQIP) database was reviewed for all outpatient procedures. Readmission rates were calculated for all ten tracked surgical specialties (general, thoracic, vascular, cardiac, orthopedics, otolaryngology, plastics, gynecology, urology, and neurosurgery). Multivariate logistic regression models were used to determine predictors of readmission for plastic surgery.

Results: A total of 7005 outpatient plastic surgery procedures were isolated. Outpatient plastic surgery had a low associated readmission rate (1.94%) compared to other specialties; Figure 1. Seventy-five patients were readmitted with at least one complication. Examination of this cohort revealed that deep surgical site infection was the most prevalent surgical complication. Multivariate regression analysis revealed obesity (BMI≥ 30), wound infection within 30 days of the index surgery, and ASA class 3 or 4 as significant predictors for readmission.

Conclusion: Readmission after outpatient plastic surgery is infrequent and compares favorably to rates of readmission among other specialties. Obesity, wound infection within 30 days of the operation, and ASA class 3 or 4 are independent predictors of readmission. As procedures continue to transition into outpatient settings and financial penalties associated with readmission become a reality, these findings will serve to optimize outpatient surgery utilization.

Figure 1: Hospital readmission rates following outpatient surgery by subspecialty

22202 Predictors Of Readmission After Outpatient Plastic Surgery