title: Predictors of readmission after breast reconstruction: a multi-institutional analysis of 5012 patients.
abstract: BACKGROUND
  Recent health care legislation institutes penalties for surgical readmissions secondary to complications. There is a paucity of evidence describing risk factors for readmission after breast reconstruction procedures.
  
  
  METHODS
  Patients undergoing breast reconstruction in 2011 were identified in the National Surgical Quality Improvement Program database. Patients were grouped as purely immediate implant/tissue-expander reconstructions or purely autologous reconstruction for analysis. Reconstructions involving multiple types of procedures were excluded due to difficulty with classification. Perioperative variables were analyzed using χ and Student t test as appropriate. Multivariate regression modeling was used to identify risk factors for readmission.
  
  
  RESULTS
  Of 5012 patients meeting inclusion criteria, 3960 and 1052 underwent implant/expander and autologous reconstructions, respectively. Implant/expander and autologous cohorts experienced similar readmission rates (4.34% vs 5.32%, respectively; P = 0.18). However, autologous reconstructions experienced a higher rate of overall complications than implant/expander reconstructions (19.96% vs 5.86%, respectively; P < 0.05), as well as higher rates of reoperation (9.7% vs 6.5%, respectively; P < 0.05). Common predictors of readmission for implant/expander and autologous cohorts included operative time, American Society of Anesthesiologist class 3 and 4, and superficial surgical site infection. Smoking, sepsis, deep wound infection, organ space infection, and wound disruption were predictive of readmission for implant/expander reconstruction only, whereas hypertension was predictive of readmission after autologous reconstruction only.
  
  
  CONCLUSIONS
  This is the first study of readmission rates after breast reconstruction. Knowledge of specific risk factors for readmission may improve patient outcomes, steer strategies for optimizing reconstructive outcomes, and minimize readmissions.
authors.affiliation: From the *Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL; †Department of Plastic Surgery, University of Tennessee Health Science Center, Memphis, TN; and ‡Rosalind Franklin University of Medicine and Science, Chicago Medical School, North Chicago, IL.
authors.forename: Alexei S
authors.initials: AS
authors.lastname: Mlodinow
authors.forename: Jon P
authors.initials: JP
authors.lastname: Ver Halen
authors.forename: Seokchun
authors.initials: S
authors.lastname: Lim
authors.forename: Seokchum
authors.initials: S
authors.lastname: Lim
authors.forename: Khang T
authors.initials: KT
authors.lastname: Nguyen
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Gaido
authors.forename: John Y S
authors.initials: JY
authors.lastname: Kim
mesh_terms: D000328:Adult; D019928:Breast Implantation / Q000295:instrumentation; D018427:Breast Implants; D001943:Breast Neoplasms / Q000601:surgery; D016208:Databases, Factual; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D016015:Logistic Models; D016462:Mammaplasty / Q000295:instrumentation / Q000379:methods; D008408:Mastectomy; D008875:Middle Aged; D015999:Multivariate Analysis; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology / Q000601:surgery; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D013524:Surgical Flaps / Q000637:transplantation; D015625:Tissue Expansion Devices; D016896:Treatment Outcome