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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. Parrish, M.D., Major Nickolay P. Markov, M.D., R. Michael Johnson, M.D., M.P.H., Major Justin P. Fox M.D., M.H.S.
Wright State University
2019-02-12
Presenter: Andrew Parrish, MD
Affidavit:
I certify that this research project has not been previously published in a scientific journal or presented at a major meeting. The below percentages accurately reflect the original work of the submitting resident physician.
Director Name: R Michael Johnson, MD, MPH
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background: The American Society of Plastic Surgeons has proposed hospital length of stay and readmission as measures of quality following breast reconstruction. We conducted this study of a nationally representative patient sample to quantify current performance along these measures in the United States.
Methods: Using the 2013-2015 Nationwide Readmissions Database, we identified female breast cancer patients who underwent inpatient mastectomy with or without reconstruction from January 1, 2013 to August 31, 2015. Patients were grouped according to treatment: mastectomy alone or with expander, tissue, or direct-to-implant (DTI) reconstruction. The primary outcomes were hospital length of stay and readmission within 30 days of discharge. Rates and trends were assessed using regression models.
Results: The final sample included 91,330 patients who underwent mastectomy alone (48.5%) or with expander (35.1%), tissue (11.2%), or DTI (5.3%) reconstruction. Throughout the study period, the reconstruction rate increased by 19% (p<0.001) with notable increases among tissue (+30.4%, p<0.001) and DTI (+30.0%, p=0.003) cohorts. The overall, mean length of stay was 2.1 days (standard deviation (STD)=2.0), which varied from 1.8 (STD=1.0; expander/DTI) to 4.0 (2.1; tissue) days. The overall hospital readmission rate was 5.5%, which varied from 5.1% (expander/DTI) to 6.3% (tissue). Trends in both hospital length of stay (p=0.532) and readmissions (p=0.853) were stable over the study period.
Conclusions: Hospital length of stay and readmissions after breast reconstruction remained stable throughout the study period. This data may serve as a baseline rate for each outcome and help inform local quality improvement efforts.
