Abstract:
BACKGROUND:Greater provider volume is associated with better outcomes. There is, however, a paucity of evidence on volume-outcome associations for surgical complications and 30-day all-cause rehospitalization after free tissue transfer or free flap surgery. Surgical complications and frequent rehospitalization are important quality indicators that substantially hinder appropriate health care spending. The authors hypothesized that increased provider volume and surgeon experience are associated with lower complication and hospital readmission rates. METHODS:The authors conducted a retrospective cohort study of adults aged 18 to 64 years who underwent free tissue transfer. They examined 100 percent of all free tissue transfers between 2001 and 2012 using Taiwan's national data, and used regression modeling to examine associations between volume and outcome. All models were adjusted for patient, surgeon, and hospital characteristics. RESULTS:Seventeen percent of free tissue transfer operations (4201 of 25,327) had complications. Infection was the most prevalent after free tissue transfer (70 percent), and the 30-day rehospitalization rate was approximately 20 percent. Hospital volume was associated with a small decrease in complications (OR, 0.99; 95 percent CI, 0.99 to 0.99; p < 0.01). For surgeons, years of experience and not annual case volume decreased surgical complications (OR, 0.98; 95 percent CI, 0.97 to 0.99; p = 0.01). The authors did not find any association between hospital or surgeon volume, or surgeon's years of experience and 30-day rehospitalization. CONCLUSIONS:Higher-volume hospitals and more experienced surgeons were shown to have a lower likelihood of postsurgery complications. Hospital process and structure affect outcomes and reduce surgical complications. Reducing 30-day rehospitalization may require payment reform, as it demands coordinated care before and after hospital discharge. CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, III.
journal_name
Plast Reconstr Surgjournal_title
Plastic and reconstructive surgeryauthors
Mahmoudi E,Lu Y,Chang SC,Lin CY,Wang YC,Chang CJ,Cheng MH,Chung KCdoi
10.1097/PRS.0000000000003515subject
Has Abstractpub_date
2017-08-01 00:00:00pages
403-411issue
2eissn
0032-1052issn
1529-4242pii
00006534-201708000-00031journal_volume
140pub_type
杂志文章,多中心研究abstract:BACKGROUND:Preservation of the scroll area is essential when performing rhinoplasty to achieve a good functional outcome. This is of particular concern with tip-plasty procedures. The objectives of this study were (1) to describe a novel tip-plasty procedure consisting of sliding the cephalic portion of the alar cartil...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0000000000005991
更新日期:2019-09-01 00:00:00
abstract::The purpose of this paper is an assessment of clinically evident systemic health problems associated with failed silicone gel breast implants. A computer search of the medical records of 2033 patients receiving implants in the years 1962-1992 revealed that between 1970 and 1992, 200 women 14 to 75 years of age underwe...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199408000-00012
更新日期:1994-08-01 00:00:00
abstract::This study questions previous reports of the presence of micrometer-sized areas of crystalline silica in pathologic tissue sections that are based exclusively on polarized-light microscopy. By using optical principles, it can be argued that it is impossible to identify unambiguously or to detect the birefringence of c...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199904040-00028
更新日期:1999-04-01 00:00:00
abstract::The purpose of the study was to determine the feasibility of preserving ovarian function after heterotopic transplantation by means of microvascular anastomosis of the transplanted vascular pedicles to a set of preselected vessels. Six groups of 10 Sprague-Dawley inbred rats were used in this study. Group I underwent ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/01.PRS.0000055731.22839.74
更新日期:2003-04-15 00:00:00
abstract::Split-thickness skin grafts remain central to the strategy of burn wound treatment. The dressing used to cover the donor wound site has a significant effect on healing parameters. The purpose of this study was to compare split-thickness skin graft donor site reepithelialization under Xeroform and Jelonet dressings. A ...
journal_title:Plastic and reconstructive surgery
pub_type: 临床试验,杂志文章
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更新日期:2003-08-01 00:00:00
abstract::We propose a simple one-stage procedure for nipple reconstruction. The fundamental basis, the technique itself, and the results obtained demonstrate that a single-flap reconstruction achieves a nipple that will keep its shape 15 months later. ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-198406000-00026
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journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-198209000-00004
更新日期:1982-09-01 00:00:00
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journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-198509000-00015
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journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
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更新日期:2010-01-01 00:00:00
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journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
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pub_type: 杂志文章
doi:10.1097/01.prs.0000475770.14396.1e
更新日期:2016-02-01 00:00:00
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journal_title:Plastic and reconstructive surgery
pub_type: 历史文章,杂志文章
doi:10.1097/00006534-198406000-00028
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journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199910000-00020
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journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章,随机对照试验
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更新日期:2015-12-01 00:00:00
abstract:BACKGROUND:The purpose of this study was to determine whether computer-morphed images convey realistic expectations of the postoperative cosmetic result to patients seeking rhinoplasty. METHODS:This was a retrospective study in which preoperative, computer-morphed, and 1-year postoperative images of 25 consecutive rhi...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/01.prs.0000254825.41066.f2
更新日期:2007-04-01 00:00:00
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journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-200206000-00007
更新日期:2002-06-01 00:00:00
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journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199209000-00016
更新日期:1992-09-01 00:00:00
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journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0b013e3182589c45
更新日期:2012-08-01 00:00:00
abstract::For the reconstructive plastic surgeon, knowledge of the molecular biology underlying membranous fracture healing is becoming increasingly vital. Understanding the complex patterns of gene expression manifested during the course of membranous fracture repair will be crucial to designing therapies that augment poor fra...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
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pub_type: 杂志文章,评审
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journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章,评审
doi:
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pub_type: 杂志文章
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更新日期:2007-12-01 00:00:00
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journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-200105000-00005
更新日期:2001-05-01 00:00:00
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journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
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更新日期:2011-11-01 00:00:00
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journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-198007000-00020
更新日期:1980-07-01 00:00:00
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journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-198611000-00012
更新日期:1986-11-01 00:00:00
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journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0b013e318221dc2a
更新日期:2011-09-01 00:00:00
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journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0b013e31824a2bdd
更新日期:2012-05-01 00:00:00
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journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/01.prs.0000244829.68008.21
更新日期:2007-01-01 00:00:00
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journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章,评审
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更新日期:2007-12-01 00:00:00