Philadelphia, Pa. From the Division of Plastic Surgery, Hospital of the University of Pennsylvania.
Plast Reconstr Surg. 2014 Aug;134(2):193e-201e. doi: 10.1097/PRS.0000000000000319.
With health reform increasingly focused on readmission rates as an indicator of quality of care, providers have a duty to identify patients at risk of readmission. The authors assessed the incidence and risk factors for readmission following immediate breast reconstruction.
Patients who underwent immediate breast reconstruction were identified through the 2011 American College of Surgeons National Surgical Quality Improvement Program database. Patients were grouped by readmission or no readmission and analyzed for trends in comorbidities and intraoperative characteristics. A multivariate regression analysis was performed to identify independently associated predictors of readmission.
Overall, 3097 patients underwent immediate breast reconstruction; 5.8 percent were readmitted within 30 days of discharge. Readmitted patients had significantly higher body mass index [28.7 (6.6) versus 27.0 (6.5) kg/m2; p=0.005], were more likely to be smokers (17.2 percent versus 11.7 percent; p=0.03), and were more likely to have comorbid conditions (37.2 percent versus 26.1 percent; p=0.005). Readmitted patients were more likely to experience surgical complications as inpatients (1.7 percent versus 0.3 percent; p=0.02) or outpatients (40.6 percent versus 2.6 percent; p<0.001). On multivariate regression analysis, readmission was associated with smoking (OR=1.60; p=0.027) and obesity (OR=1.62; p=0.004), while total length of stay and inpatient surgical complications neared significance.
Patients undergoing immediate breast reconstruction should be identified and risk-stratified appropriately if they are obese, smokers with extended length of stay, or have surgical complications. Early identification may reduce the impact of readmission on the patient or minimize the likelihood of readmission altogether, whether via greater scrutiny before discharge or frequent postdischarge follow-up.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
随着医疗改革越来越关注再入院率作为医疗质量的指标，提供者有责任识别有再入院风险的患者。作者评估了即刻乳房重建后再入院的发生率和危险因素。
通过 2011 年美国外科医师学院国家手术质量改进计划数据库确定接受即刻乳房重建的患者。根据再入院或未再入院将患者分组，并分析合并症和术中特征的趋势。进行多变量回归分析以确定再入院的独立相关预测因素。
总体而言，3097 例患者接受了即刻乳房重建；5.8%的患者在出院后 30 天内再次入院。再入院患者的体重指数明显更高[28.7（6.6）与 27.0（6.5）kg/m2；p=0.005]，更有可能吸烟（17.2%与 11.7%；p=0.03），并且更有可能患有合并症（37.2%与 26.1%；p=0.005）。再入院患者更有可能在住院期间（1.7%与 0.3%；p=0.02）或门诊期间（40.6%与 2.6%；p<0.001）发生手术并发症。多变量回归分析显示，再入院与吸烟（OR=1.60；p=0.027）和肥胖（OR=1.62；p=0.004）相关，而总住院时间和住院手术并发症接近显著。
如果肥胖、吸烟、延长住院时间或有手术并发症的即刻乳房重建患者应进行识别和适当的风险分层。早期识别可能会降低再入院对患者的影响，或者通过在出院前进行更严格的审查或频繁的出院后随访，尽量减少再入院的可能性。
临床问题/证据水平：风险，III 级。
