title: Assessing Outcomes and Safety of Inpatient Versus Outpatient Tissue Expander Immediate Breast Reconstruction.
abstract: BACKGROUND
  With the rising cost of healthcare delivery and bundled payments for episodes of care, there has been impetus to minimize hospitalization and increase utilization of outpatient surgery mechanisms. Given the increase in outpatient mastectomy and immediate tissue expander (TE)-based reconstruction and the paucity of data on its comparative safety to inpatient procedures, we sought to understand the risk for early postoperative complications in an outpatient model compared with more traditional inpatient status using the National Surgical Quality Improvement Program database.
  
  
  METHODS
  NSQIP data files from 2005 to 2012 were queried to identify patients undergoing immediate TE-based breast reconstruction after mastectomy. Patients were stratified by whether they received outpatient or inpatient care and then propensity score matched based on preoperative baseline characteristics to produce matched cohorts. Multivariate regression analysis was used to determine whether outpatient versus inpatient status conferred differing risk for 30-days complications.
  
  
  RESULTS
  Of the 2014 patients who met criteria, 1:1 propensity matching yielded 634 patients in each of the matched cohorts. Overall complications (5.2 vs. 5.4 %), overall surgical complications (4.3 vs. 3.9 %), overall medical complications (1.3 vs. 2.1 %), and return to the operating room (6.6 vs. 7.3 %) were similar between outpatient and inpatients cohorts (p > .2), respectively. There was a small, but significant increased risk of organ/space SSI in outpatients (1.9 vs. 0.5 %, p = .02) and trend for increased risk for pulmonary embolus (PE) and urinary tract infection (UTI) in inpatients (0.3 vs. 0 %, p = .16; 0.3 vs. 0 %, p = .16).
  
  
  CONCLUSIONS
  Our studies suggest that outpatient TE confers similar safety profiles to inpatient TE with regards to 30-day postoperative overall complications, medical and surgical morbidity, and return to the operating room. A slightly increased risk for surgical site infection must be balanced against potential risk for known inpatient-related complications such as UTI and PE.
authors: Department of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
authors: Charles
authors: C
authors: Qin
authors: Division of Plastic, Reconstructive, and Cosmetic, Surgery, University of Illinois at Chicago, Chicago, IL, USA.
authors: Anuja K
authors: AK
authors: Antony
authors: Department of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
authors: Apas
authors: A
authors: Aggarwal
authors: Department of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
authors: Sumanas
authors: S
authors: Jordan
authors: Division of Plastic Surgery, Department of Surgery, University of Illinois, Chicago, IL, USA.
authors: Karol A
authors: KA
authors: Gutowski
authors: Department of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA. jokim@nmh.org.
authors: John Y S
authors: JY
authors: Kim
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000592:standards / Q000706:statistics & numerical data*; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects*; D019928:Breast Implantation / Q000009:adverse effects*; D018427:Breast Implants / Q000009:adverse effects; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D057216:Propensity Score; D011655:Pulmonary Embolism / Q000209:etiology; D012086:Reoperation; D013530:Surgical Wound Infection / Q000209:etiology*; D013997:Time Factors; D015626:Tissue Expansion / Q000009:adverse effects; D014552:Urinary Tract Infections / Q000209:etiology