title: Lessons learned from the American College of Surgeons National Surgical Quality Improvement Program Database: has centralized data collection improved immediate breast reconstruction outcomes and safety?
abstract: BACKGROUND
  The American College of Surgeons National Surgical Quality Improvement Program database was implemented to longitudinally track surgical 30-day surgical outcomes and complications. The authors analyze the program-reported outcomes for immediate breast reconstruction from 2007 to 2011, to assess whether longitudinal data collection has improved national outcomes and to highlight areas in need of continued improvement.
  
  
  METHODS
  The authors reviewed the database from 2007 to 2011 and identified encounters for immediate breast reconstruction using Current Procedural Terminology codes for prosthetic and autologous reconstruction. Demographics and comorbidities were tabulated for all patients. Postoperative complications analyzed included surgical-site infection, wound dehiscence, implant or flap loss, pulmonary embolism, and respiratory infections.
  
  
  RESULTS
  A total of 15,978 patients underwent mastectomy and immediate reconstruction. Fewer smokers underwent immediate reconstruction over time (p=0.126), whereas more obese patients (p=0.001) and American Society of Anesthesiologists class 3 and 4 patients (p<0.001) underwent surgery. An overall increase in superficial surgical-site infection was noted, from 1.7 percent to 2.3 percent (p=0.214). Wound dehiscence (p=0.036) increased over time, whereas implant loss (p=0.015) and flap loss (p=0.012) decreased over time. Mean operative times increased over the analyzed years, as did all complications for prosthetic and autologous reconstruction.
  
  
  CONCLUSIONS
  The American College of Surgeons National Surgical Quality Improvement Program data set has shown an increase in complications for immediate breast reconstruction over time, because of a longitudinally higher number of comorbid patients and longer operative times. This knowledge allows plastic surgeons the unique opportunity to improve patient selection criteria and efficiency.
  
  
  METHODS
  Therapeutic, III.
authors: San Francisco, Calif.; and Rochester, N.Y. From the Division of Plastic and Reconstructive Surgery, University of California, San Francisco; and the Division of Plastic and Reconstructive Surgery, University of Rochester.
authors: Frederick
authors: F
authors: Wang
authors: Peter F
authors: PF
authors: Koltz
authors: Hani
authors: H
authors: Sbitany
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008408:Mastectomy / Q000009:adverse effects / Q000379:methods*; D016347:Medical Records Systems, Computerized / Q000458:organization & administration; D008875:Middle Aged; D011184:Postoperative Period; D011379:Prognosis; D015397:Program Evaluation; D011475:Prosthesis Failure; D058996:Quality Improvement / Q000458:organization & administration*; D012955:Societies, Medical; D013529:Surgical Wound Dehiscence / Q000453:epidemiology; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000503:physiopathology; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States