Abstract: Independent Predictors of Readmission in Autologous Breast Reconstruction (Plastic Surgery 2015)

Sunday, October 18, 2015: 1:45 PM

Benjamin Ballard Massenburg, BA , Icahn School of Medicine at Mount Sinai, New York, NY

Paymon Sanati-Mehrizy, BA , Icahn School of Medicine at Mount Sinai, New York, NY

Eric M Jablonka, MD , Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY

Peter J Taub, MD , Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY

Independent Predictors of Readmission in Autologous Breast Reconstruction

Purpose: The rates of readmission in breast reconstruction have been previously reported, though risk factors for readmission in autologous breast reconstruction have not been thoroughly elucidated. As readmission is a relevant and valid measure of the surgical performance of a hospital, identifying patients at risk of readmission is of utmost importance. This study aims to identify specific independent risk factors for readmission in autologous breast reconstruction.

Methods: This study retrospectively reviewed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) and identified all patients who underwent autologous breast reconstruction performed between 2011 and 2013. Univariate logistic regression analysis was used to identify significant associations between preoperative risk factors and readmission. Multivariate logistic regression analysis was then used to identify independent risk factors and causes of readmission.

Results: Of the 7,181 female patients identified who underwent autologous breast reconstruction, there were 1,529 (21.3%) latissimus dorsi (LD) flaps, 1,133 (15.8%) transverse rectus abdominus myocutaneous (TRAM) flaps, and 2,760 (38.4%) free flaps performed. Overall, there were 425 (5.9%) readmissions in autologous breast reconstruction, with 87 (5.7%) readmissions in LD flaps, 95 (8.4%) readmissions in TRAM flaps, and 180 (6.5%) readmissions in free flaps. Multivariate regression analysis demonstrated that age, ASA class of 3 or greater, cigarette smoking, diabetes mellitus, prolonged operative times, and prolonged initial admissions were independent risk factors for readmission. Additionally, having a TRAM flap reconstruction was an independent risk factor for readmission when controlling for confounding variables.

Conclusions: These risk factors can aid in patient selection, flap selection, surgical planning, and post-operative allocation of resources for patients undergoing autologous breast reconstruction.

Table 1. Univariate analysis on patient demographics and preoperative risk factors for readmission.

Table 2. Multivariate regression analysis identifying independent risk factors for readmission.

27013 Independent Predictors of Readmission in Autologous Breast Reconstruction