From the College of Medicine, Medical University of South Carolina.
Division of Plastic Surgery, Medical University of South Carolina.
Ann Plast Surg. 2023 Jun 1;90(6S Suppl 4):S395-S402. doi: 10.1097/SAP.0000000000003459. Epub 2023 Feb 18.
Currently, overnight admission after immediate implant-based breast reconstruction (IBR) is the standard of care. Our study aims to analyze the safety, feasibility, and outcomes of immediate IBR with same-day discharge as compared with the standard overnight stay.
The 2015-2020 National Surgical Quality Improvement Program database was reviewed to identify all patients undergoing mastectomy with immediate IBR for malignant breast disease. Patients were stratified into study (patients discharged day of surgery) and control (patients admitted after surgery) groups. Patient demographics, comorbidities, surgical characteristics, implant type, wound complications, readmission, and reoperation rates were collected and analyzed. Univariate and multivariate logistic regression was used to determine independent predictors of same-day discharge versus admission. In addition, Pearson χ2 test was used for comparison of proportions and t test was used for continuous variables unless distributions required subsequent nonparametric analyses. Statistical significance was defined as a P value less than 0.05.
A total of 21,923 cases were identified. The study group included 1361 patients discharged same day and the control group included 20,562 patient s admitted for average of 1.4 days (range, 1-86). Average age was 51 years for both groups. Average body mass index for the study group 27 and 28 kg/m2 for the control group, respectively. Total wound complication rates were similar (4.5% study, 4.3% control, P = 0.72). Reoperation rates were lower with same-day discharge (5.7% study, 6.8% control, P = 0.105), though not statistically significant. However, same-day discharge patients had a significantly lower readmission rate compared with the control (2.3% study, 4.2% control, P = 0.001).
National Surgical Quality Improvement Program data analysis over a 6-year period reveals that immediate IBR with same-day discharge is associated with a significantly lower readmission rate when compared with the standard overnight stay. The comparable complication profiles show that immediate IBR with same-day discharge is safe, potentially benefiting both patients and hospitals.
目前，即时植入型乳房重建（IBR）后过夜入院是标准的护理方式。我们的研究旨在分析即时 IBR 即刻出院与标准过夜住院的安全性、可行性和结果。
回顾了 2015 年至 2020 年国家手术质量改进计划数据库，以确定所有因恶性乳腺疾病接受乳房切除术和即时 IBR 的患者。患者分为研究（手术当天出院的患者）和对照组（手术后入院的患者）。收集并分析了患者的人口统计学、合并症、手术特征、植入物类型、伤口并发症、再入院和再次手术率。使用单变量和多变量逻辑回归确定即刻出院与入院的独立预测因素。此外，对于比例比较使用 Pearson χ2 检验，对于连续变量使用 t 检验，除非分布需要随后的非参数分析。统计显著性定义为 P 值小于 0.05。
共确定了 21923 例病例。研究组包括 1361 例当天出院的患者，对照组包括 20562 例平均住院 1.4 天（范围为 1-86 天）的患者。两组患者的平均年龄均为 51 岁。研究组的平均体重指数为 27kg/m2，对照组为 28kg/m2。总的伤口并发症发生率相似（研究组为 4.5%，对照组为 4.3%，P=0.72）。即刻出院患者的再手术率较低（研究组为 5.7%，对照组为 6.8%，P=0.105），但无统计学意义。然而，与对照组相比，即刻出院患者的再入院率显著降低（研究组为 2.3%，对照组为 4.2%，P=0.001）。
国家手术质量改进计划数据分析显示，即时 IBR 即刻出院与标准过夜住院相比，再入院率显著降低。类似的并发症谱表明，即时 IBR 即刻出院是安全的，可能使患者和医院都受益。
