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Reduction Mammaplasty: A Comparison Of Inpatient Versus Outpatient Surgery Using NSQIP.
Tyler A. Evans MD, Tahereh Soleimani MD MPH, Ivan Hadad MD, Juan Socas MD, Rajiv Sood MD, Sunil S. Tholpady MD PhD
Indiana University School of Medicine, Division of Plastic Surgery
2015-03-15
Presenter: Tyler A. Evans MD
Affidavit:
Resident was responsible for entire project, with assistance from faculty
Director Name: Rajiv Sood
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Introductions: Outpatient reduction mammaplasty has become a common practice amongst plastic surgeons. Previous studies have shown inpatient breast reductions are associated with complications. This study was designed to investigate predictors of inpatient reduction mammaplasty and to evaluate outcomes of inpatient versus outpatient surgery.
Methods: Using the 2011-2012 ACS-NSQIP databases, female patients with CPT for breast reduction were selected and divided into inpatient and outpatient procedures. Differences in age, BMI, ASA, and comorbidities were examined between the two groups. To adjust for potential selection bias, probability of inpatient care was calculated via propensity score method. Both groups were compared in terms of 30 day postoperative complications, readmission, and reoperation rates.
Results: 4,553 patients were divided into inpatient (574,12.6%) and outpatient (3,979,87.4%) groups. Increased age, ASA, BMI, DM, and COPD correlated with having inpatient surgery. The complication rate for outpatient procedures was 4.96% and 8.36% for inpatient procedures. Readmission rates were 1.09% and 5.13%, respectively. Similarly, reoperation rates were 1.82% and 3.89% in the respective groups. Inpatient reduction mammaplasty was associated with an increased risk of complication, readmission, and reoperation despite propensity score adjustment.
Conclusions: Reduction mammaplasty performed in outpatient centers appears to have low early complication, reoperation and readmission rates. Although the significant comorbidities and other factors discussed in this study correlate with having inpatient surgery, the causes of higher complication and readmission/reoperation rates in the inpatient setting are yet to be identified. Further studies are needed to isolate these factors to improve pre-operative selection of inpatient versus outpatient reduction mammaplasty.
