title: Perioperative outcomes of autologous breast reconstruction surgery in teaching versus nonteaching hospitals.
abstract: BACKGROUND
  The aims of this study were (1) to evaluate the frequency of various reconstructive techniques for autologous breast reconstruction and (2) to compare perioperative outcomes of autologous breast reconstruction in teaching versus nonteaching hospitals.
  
  
  METHODS
  The authors analyzed clinical data of patients who underwent autologous breast reconstructive surgery from 2009 to 2010 using the Nationwide Inpatient Sample database. Autologous breast reconstruction operations included latissimus dorsi myocutaneous, pedicled transverse rectus abdominis myocutaneous (TRAM), free TRAM, free deep inferior epigastric artery perforator (DIEP), free superficial inferior epigastric artery, and free gluteal artery perforator flaps.
  
  
  RESULTS
  A total of 35,883 patients underwent autologous breast reconstructive surgery in that period. Most reconstructions were performed in teaching hospitals (74 percent). The two most common breast reconstruction types in teaching hospitals were latissimus dorsi myocutaneous (26 percent) and DIEP flaps (26 percent), compared with latissimus dorsi myocutaneous (39 percent) and pedicled TRAM flaps (22 percent) in nonteaching hospitals. In addition, the rate of free flap breast reconstruction was significantly higher in teaching hospitals (46 percent) compared with nonteaching hospitals (31 percent) (p < 0.01). There was no statistically significant difference for total in-hospital complication rate (teaching, 6.9 percent; nonteaching, 7.1 percent; p = 0.54) or total in-hospital mortality rate (teaching, 0.04 percent; nonteaching, 0.05 percent; p = 0.56).
  
  
  CONCLUSIONS
  Three-fourths of autologous breast reconstructions performed from 2009 to 2010 were performed in teaching hospitals, with free flaps also more likely to be performed in teaching hospitals. Despite more complex free flap breast reconstructions being performed in teaching hospitals, there was no statistically significant difference in perioperative outcomes (morbidity and mortality) between teaching and nonteaching hospitals.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Orange, Calif. From the Aesthetic & Plastic Surgery Institute, University of California, Irvine Medical Center.
authors.forename: Hossein
authors.initials: H
authors.lastname: Masoomi
authors.forename: Garrett A
authors.initials: GA
authors.lastname: Wirth
authors.forename: Keyianoosh Z
authors.initials: KZ
authors.lastname: Paydar
authors.forename: Brandon K
authors.initials: BK
authors.lastname: Richland
authors.forename: Gregory R D
authors.initials: GRD
authors.lastname: Evans
mesh_terms: D000368:Aged; D064592:Autografts; D005260:Female; D058752:Free Tissue Flaps; D006784:Hospitals, Teaching; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome