The American College of Surgeons National Quality Improvement Program Incompletely Captures Implant-Based Breast Reconstruction Complications

Abstract

Background Implant-based breast reconstruction (IBR) accounts for 70% of postmastectomy reconstructions in the United States. Improving the quality of surgical care in IBR patients through accurate measurements of outcomes is necessary. The purpose of this study is to compare the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) data from our institution to our complete institutional health records database. Methods Data were collected and recorded for all patients undergoing IBR at our institution from 2015 to 2017. The data were completely identified and compared with our institutional NSQIP database for demographics and complications. Results The electronic health records data search identified 768 IBR patients in 3 years and NSQIP reported on 229 (30%) patients. Demographics were reported similarly among the 2 databases. Rates of tissue expander/implant infections (5.9% vs 1.8%; P = 0.003) and wound dehiscence (3.5% vs 0.4%; P = 0.003) were not reported similarly between our database and NSQIP. However, the rates of hematoma (2.7% vs 1.8%) and skin flap necrosis (2.5% vs 1.8%) were comparable between the two databases. In our database, 43% of all complications presented after 30 days of surgery, beyond NSQIP's capture period. Conclusions Databases built on partial sampling, such as the NSQIP, may be useful for demographic analyses, but fall short of providing data for complications after IBR, such as infections and wound dehiscence. These results highlight the utility and importance of complete databases. National comparisons of clinical outcomes for IBR should be interpreted with caution when using partial databases.

Efficacy of the Modified 5-Item Frailty Index in Predicting Surgical-Site Infections in Patients Undergoing Breast Implant Augmentation: A National Surgical Quality Improvement Project-Based 5-Year Study

“…NSQIP is designed to record surgical procedures across specialties and does not contain breast-specific complications, such as seroma, rippling, capsular contracture, malposition, and outcomes. 31 Furthermore, NSQIP is limited to a 30-day window, and many complications, such as rippling, capsular contracture, double capsules, and late seromas, occur past this timeframe. This can lead to a false lower rate of complications.…”

Breast Reconstruction After Mastectomy: A Systematic Review and Meta-Analysis

“…7 Federal regulations require that health insurance policies that cover mastectomy also cover breast reconstruction. 8 Breast reconstruction is also offered to women who undergo mastectomy for prophylaxis against breast cancer, such as women with high-risk gene mutations such as BRCA1 and BRCA2. [9][10][11] For women who choose breast reconstruction surgery, two main considerations must be made: timing and type of reconstruction.…”