title: Increased hospital volume is associated with improved outcomes following abdominal-based breast reconstruction.
abstract: Previous studies of outcomes following abdominal-based breast reconstruction largely use data from single-centre/surgeon experience. Such studies are limited in evaluating the effect of operative volume on outcomes. Abdominal-based breast reconstructive procedures were identified in the 2009-2010 HCUP Nationwide Inpatient Sample. Outcomes included in-hospital microvascular complications in free flap cases (requiring exploration/anastomosis revision), procedure-related and total complications in all cases, and length of stay (LOS). High-volume hospitals were defined as 90th percentile of case volume or higher (>30 flaps/year). Univariate and multivariate analyses were performed to identify predictors of outcomes. Of the 4107 patients identified, mean age was 50.7 years; 71% were white, 68% underwent free flap reconstruction, and 25% underwent bilateral reconstruction. The total complication rate was 13.2%, and the microvascular complication rate was 7.0%. Mean LOS was 4.5 days. There were 436 hospitals; 59% of cases were performed at high-volume institutions. Patients at high-volume hospitals more often underwent free flap reconstruction compared to low-volume hospitals (82.4% vs 50.5%, p < 0.001). On unadjusted analysis, microvascular complication rates of 6.4% vs 8.2% were observed for high-volume compared to low-volume hospitals (p = 0.080). After adjusting for case-mix, high-volume hospitals were associated with a decreased likelihood of suffering a microvascular complication (OR = 0.71, p = 0.026), procedure-related complication (OR = 0.79, p = 0.033), or total complication (OR = 0.75, p = 0.004). The majority of cases nationwide are performed at a small number of high-volume hospitals. These hospitals appear to discharge patients earlier and have lower microvascular, procedure-related, and total complication rates when controlling for case-mix.
authors.affiliation: Yale University School of Medicine, Department of Surgery, Section of Plastic and Reconstructive Surgery , New Haven, CT , USA.
authors.forename: Charles T
authors.initials: CT
authors.lastname: Tuggle
authors.forename: Anup
authors.initials: A
authors.lastname: Patel
authors.forename: Niclas
authors.initials: N
authors.lastname: Broer
authors.forename: John A
authors.initials: JA
authors.lastname: Persing
authors.forename: Julie A
authors.initials: JA
authors.lastname: Sosa
authors.forename: Alexander F
authors.initials: AF
authors.lastname: Au
mesh_terms: D000328:Adult; D005260:Female; D061847:Hospitals, High-Volume; D006801:Humans; D016462:Mammaplasty; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care
keywords: Breast reconstruction; microvascular; outcomes; plastic surgery