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Risk of readmission following immediate breast reconstruction: results from the 2011 American College of Surgeons National Surgical Quality Improvement Program data sets.

Abstract：

BACKGROUND:With health reform increasingly focused on readmission rates as an indicator of quality of care, providers have a duty to identify patients at risk of readmission. The authors assessed the incidence and risk factors for readmission following immediate breast reconstruction. METHODS:Patients who underwent immediate breast reconstruction were identified through the 2011 American College of Surgeons National Surgical Quality Improvement Program database. Patients were grouped by readmission or no readmission and analyzed for trends in comorbidities and intraoperative characteristics. A multivariate regression analysis was performed to identify independently associated predictors of readmission. RESULTS:Overall, 3097 patients underwent immediate breast reconstruction; 5.8 percent were readmitted within 30 days of discharge. Readmitted patients had significantly higher body mass index [28.7 (6.6) versus 27.0 (6.5) kg/m2; p=0.005], were more likely to be smokers (17.2 percent versus 11.7 percent; p=0.03), and were more likely to have comorbid conditions (37.2 percent versus 26.1 percent; p=0.005). Readmitted patients were more likely to experience surgical complications as inpatients (1.7 percent versus 0.3 percent; p=0.02) or outpatients (40.6 percent versus 2.6 percent; p<0.001). On multivariate regression analysis, readmission was associated with smoking (OR=1.60; p=0.027) and obesity (OR=1.62; p=0.004), while total length of stay and inpatient surgical complications neared significance. CONCLUSIONS:Patients undergoing immediate breast reconstruction should be identified and risk-stratified appropriately if they are obese, smokers with extended length of stay, or have surgical complications. Early identification may reduce the impact of readmission on the patient or minimize the likelihood of readmission altogether, whether via greater scrutiny before discharge or frequent postdischarge follow-up. CLINICAL QUESTION/LEVEL OF EVIDENCE:Risk, III.

journal_name

Plast Reconstr Surg

journal_title

Plastic and reconstructive surgery

authors

Nelson JA,Fischer JP,Chung C,Wu LC,Serletti JM,Kovach SJ

doi

10.1097/PRS.0000000000000319

subject

Has Abstract

pub_date

2014-08-01 00:00:00

pages

193e-201e

issue

eissn

0032-1052

issn

1529-4242

pii

00006534-201408000-00003

journal_volume

134

pub_type

杂志文章

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Risk of readmission following immediate breast reconstruction: results from the 2011 American College of Surgeons National Surgical Quality Improvement Program data sets.