Abstract
Background Traditionally, surgical quality outcomes are assessed using a 30-day postoperative
window. For breast cancer patients undergoing free tissue transfer for breast reconstruction,
we sought to describe the distribution of and specific risk factors for early and
late readmissions within a 0- to 90-day postoperative period.
Patients and Methods The Nationwide Readmissions Database was used to conduct a retrospective cohort study.
Breast cancer patients undergoing free tissue transfer for breast reconstruction were
identified using International Classification of Diseases -9 diagnosis and procedure
codes. Ninety-day readmissions related to infection or wound complications were identified.
Univariable and multivariable logistic regression models were used to identify patient
risk factors for readmissions that occurred early (0–30 days) and late (31–90 days)
after their index procedure.
Results In the weighted sample, we identified approximately 7,305 free flap breast reconstructions
and a surgical wound-related readmission rate of 4.3% (n = 312): 65.4% of the readmissions occurred early while 34.6% occurred late after
surgery. The mean days to readmission was 26, and 75% of all readmissions occurred
within the first 36 days after surgery. Variables independently associated with readmissions
during the 0- to 90-day postoperative period included: history of chronic obstructive
pulmonary disease (p = 0.036), hypertension (p = 0.03), obesity (p ≤ 0.001), and history of smoking (p = 0.004). The variables independently associated with the early readmission period
were the same as those identified for the 0- to 90-day postoperative period. The variables
independently associated with late readmissions were different: history of depression
(p = 0.001) and history of smoking (p = 0.001).
Conclusion The conventional 30-day hospital readmission rate classically used as a quality metric
is overlooking a significant portion of admissions after free flap-based breast reconstruction.
Different variables were found to be associated with readmission in the early versus
late cohorts. Interventions targeting these variables could decrease readmissions
and their associated costs.
Keywords
autologous breast reconstruction - readmission - free-flap
