Hospital length of stay and hospital readmission after immediate breast reconstruction in the United States: Implications for quality measurement

Parrish, Andrew J.; Markov, Nickolay P.; Johnson, R Michael; Fox, Justin P.

doi:10.1016/j.bjps.2021.09.052

Journal of Plastic, Reconstructive & Aesthetic Surgery

2022

DOI: 10.1016/j.bjps.2021.09.052

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Hospital length of stay and hospital readmission after immediate breast reconstruction in the United States: Implications for quality measurement

Andrew J. Parrish¹,

Nickolay P. Markov²,

R Michael Johnson³

et al.

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Cited by 2 publications

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“…[12][13][14] This traditionally was performed in a delayed fashion until immediate reconstruction was introduced in the 1970s, 15,16 with patients admitted overnight to monitor for complications from surgery and anesthesia, as well as pain control. 17 However, admission leads to risk of nosocomial infection, risk of thrombosis, and slower recovery rates than discharge home. 17,18 Furthermore, aggressive pain control has become less necessary given the increased popularity of prepectoral reconstruction and the introduction of enhanced recovery protocols.…”

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“…17 However, admission leads to risk of nosocomial infection, risk of thrombosis, and slower recovery rates than discharge home. 17,18 Furthermore, aggressive pain control has become less necessary given the increased popularity of prepectoral reconstruction and the introduction of enhanced recovery protocols. 19 Longer hospital stays also stress hospital resources, as demonstrated by the coronavirus pandemic, while increasing the financial burden on the patient.…”

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Investigating Same-Day Discharge For Postmastectomy Immediate Breast Reconstruction: A National Surgical Quality Improvement Program Study

Miller

Jain

Wells

et al. 2023

Plastic &Amp; Reconstructive Surgery

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reast cancer is the second leading cause of cancer-related death in American women, with more than 4 million women living with the diagnosis and more than 300,000 new diagnoses each year in the United States. 1 Given the enormous burden of this disease, there is a continued need for timely detection, optimized treatment, and preserved quality of life after treatment. [2][3][4] To reduce the need for radiation therapy and lower rates of recurrence, surgical management Background: Patients undergoing immediate breast reconstruction with tissue expanders are frequently admitted after surgery for monitoring and pain control, which introduces additional costs and risks of nosocomial infection. Same-day discharge could conserve resources, mitigate risk, and return patients home for faster recovery. The authors used large data sets to investigate the safety of same-day discharge after mastectomy with immediate postoperative expander placement. Methods: A retrospective review was performed of patients in the National Surgical Quality Improvement Program database who underwent breast reconstruction using tissue expanders between 2005 and 2019. Patients were grouped based on date of discharge. Demographic information, medical comorbidities, and outcomes were recorded. Statistical analysis was performed to determine efficacy of same-day discharge and identify factors that predict safety. Results: Of the 14,387 included patients, 10% were discharged the same day, 70% on postoperative day 1, and 20% later than postoperative day 1. The most common complications were infection, reoperation, and readmission, which trended upward with length of stay (6.4% versus 9.3% versus 16.8%), but were statistically equivalent between same-day and next-day discharge. The complication rate for later-day discharge was statistically higher. Patients discharged later had significantly more comorbidities than same or next-day discharge counterparts. Predictors of complications included hypertension, smoking, diabetes, and obesity. Conclusions: Patients undergoing mastectomy with immediate tissue expander reconstruction are usually admitted overnight. However, same-day discharge was demonstrated to have an equivalent risk of perioperative complications as next-day discharge. For the otherwise healthy patient, going home the day of surgery is a safe and cost-effective option, although the decision should be made based on the individual patient.

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confidence: 99%

mentioning

confidence: 99%

Investigating Same-Day Discharge For Postmastectomy Immediate Breast Reconstruction: A National Surgical Quality Improvement Program Study

Miller

Jain

Wells

et al. 2023

Plastic &Amp; Reconstructive Surgery

View full text Add to dashboard Cite

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Immediate Breast Reconstruction After Mastectomy for Cancer Among US Military Health System Beneficiaries

Fox,

Latham,

Darmon

et al. 2024

Ann Plast Surg

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Background In the Military Health System (MHS), women with breast cancer may undergo surgical treatment in military hospitals (direct care) or in the civilian setting via the insurance benefit (private sector care). We conducted this study to determine immediate breast reconstruction rates among women undergoing mastectomy for cancer in the MHS by setting of care. Methods Using the linked Department of Defense's Central Cancer Registry and MHS Data Repository, the Department of Defense's medical claims database, we identified adult women who underwent mastectomy for breast cancer from 1998 to 2014. Patients were then subgrouped by setting of care (direct vs private sector care). The primary outcome was the rate and type of immediate breast reconstruction. Regression models were constructed to determine factors associated with receipt of immediate breast reconstruction. Results The final sample included 3251 women who underwent mastectomy for cancer in the direct (67.0%) or private sector care (32.6%) settings. The overall rate of immediate breast reconstruction was 29.9% with an upward trend noted throughout the study (P < 0.001). Overall, implant-based reconstruction (81.4%) was more common than tissue-based reconstruction (18.6%). Compared with direct care, the immediate breast reconstruction rate was significantly higher in the private sector care setting (49.3% vs 20.5%, P < 0.001) despite accounting for differences in clinical characteristics (adjusted odds ratio = 4.51, 95% confidence interval [3.72–5.46]). Conclusions Immediate breast reconstruction in the direct care setting lags that in the civilian community during the study time period. Further research is needed to ascertain current immediate reconstruction rates and understand factors contributing to any differences in rates between care settings.

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Hospital length of stay and hospital readmission after immediate breast reconstruction in the United States: Implications for quality measurement

Cited by 2 publications

References 3 publications

Investigating Same-Day Discharge For Postmastectomy Immediate Breast Reconstruction: A National Surgical Quality Improvement Program Study

Investigating Same-Day Discharge For Postmastectomy Immediate Breast Reconstruction: A National Surgical Quality Improvement Program Study

Immediate Breast Reconstruction After Mastectomy for Cancer Among US Military Health System Beneficiaries

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