Abstract: Assessing Clinical Risk Factors for Early (30 Day) and Late (1 year) Re-Admission Following Immediate Breast Reconstruction (Plastic Surgery The Meeting)

Monday, September 26, 2016: 11:35 AM

Gabriel Klein, MD , Plastic Surgery, Stony Brook University, Stony Brook, NY

Robert Laskowski, MD, PhD , Surgery, Stony Brook University Hospital, Stony Brook, NY

Alisa Timashpolsky, MD , Plastic Surgery, Stony Brook University Medical Center, Stony Brook, NY

Danielle Lipoff, DO , Department of Surgery, Peconic Bay Medical Center, Riverhead, NY

Jie Yang, PhD , Epidemiology, Stony Brook University Hospital, Stony Brook, NY

Duc T. Bui, MD , Plastic Surgery, Stony Brook University Hospital, Stony Brook, NY

Alexander B. Dagum, MD , Plastic Surgery, Stony Brook University Medical Center, Stony Brook, NY

Sami U. Khan, MD , Plastic Surgery, Stony Brook University, Stony Brook, NY

Presentation PDF file

Purpose:

Recent changes in healthcare policy have focused on reducing postoperative complications and readmission rates. Understanding peri-operative risk factors for complications may help reduce re-admissions and operative complications resulting in an improvement in outcomes. Previous studies have investigated the NSQIP database regarding readmissions, but are limited to 30 days of follow-up. In this study we tracked all immediate breast reconstruction patients at our institution for readmissions during the first postoperative year.

Methods:

After IRB approval, retrospective analysis of all Breast Reconstruction patients who had a minimum of 1 year of follow-up from 2010-2012 was performed. Demographic data, comorbidities, complications, and readmission rates for <30 days, 31-90 days, and 91 days to 1 year, and non-admission emergency room visits for the first postoperative year were evaluated. Statistical analysis was performed using a Generalized mixed linear effect model.

Results:

353 patients were included in our study population. Readmission rates were 9.35% for <30 days, 10.76% for 31-90 days, and 20.12% for 91 days to 1 year. 30 day readmission rates were correlated with surgical site infection (OR=11.67, P<0.001), seroma (OR=5.44, P=0.0007), preoperative bra size of D or greater (OR=3.47, P=0.015), and BMI greater than 30 (OR=2.23, P=0.041). 31-90 day readmission rates were significantly increased by surgical site infection (OR=5.48, P= 0.003), implant infection (OR=7.48, P<0.001), BMI greater than 30 (OR=2.19, P= 0.024), and preoperative bra size of D or greater (OR=2.87, P= 0.015). Finally, 91 day to 1 year readmissions were linked to cancer stage 3 or 4 (OR=2.1, P= 0.013), surgical site infection (OR=4.6, P= 0.008), and implant infection (OR=63.36, P= 0.004). Surgical site infection and preoperative bra size of D or greater were both shown to be significant risk factors for emergency room visits.

Conclusions and Significance:

This study addresses one of the limitations of recent NSQIP readmissions studies, namely the short follow-up which may not capture late wound healing/infectious complications or the effects of adjuvant breast cancer therapy. The independent risks factors identified in this study may help surgeons better risk stratify their patients and thus potentially improve clinical outcomes in immediate breast reconstruction.

30295 Assessing Clinical Risk Factors for Early (30 Day) and Late (1 year) Re-Admission Following Immediate Breast Reconstruction