L Lipkin Isabella, Li Renxi, G Ranganath Bharat
George Washington University School of Medicine and Health Sciences, Washington, D.C., United States of America.
George Washington University Hospital, Washington, D.C., United States of America.
J Plast Reconstr Surg. 2024 May 10;3(4):142-150. doi: 10.53045/jprs.2023-0066. eCollection 2024 Oct 27.
Comorbidities that impair wound healing, increase infection risk, and compromise tissue viability influence rates of hospital readmission after autologous reconstruction and implant-based reconstruction. This study aimed to evaluate patient factors that increase risk for 30-day hospital readmission after autologous reconstruction and implant-based reconstruction and identify differences in the comorbidities that affect readmission risk after each method.
Patients from 2005 to 2021 were selected by autologous reconstruction and implant-based reconstruction current procedural terminology codes from the American College of Surgeons National Surgical Quality Improvement Program database. A multivariable regression model identified the significant predictors of unplanned readmission.
Comorbidities that increase risk for readmission after autologous reconstruction but not implant-based reconstruction include dialysis (OR 3.87, p = 0.042) and malnutrition (OR 3.20, p = 0.003). Risk factors for readmission after implant-based reconstruction but not autologous reconstruction include bleeding disorder (OR 2.62, p < 0.0001), previous infection (OR 1.49, p = 0.045), recent sepsis (OR 2.16 p = 0.0003), anemia (OR 1.13, p = 0.0018), and hypoalbuminemia (OR 1.35, p = 0.0213). Predictors of unplanned readmission after both methods include chronic obstructive pulmonary disorder, obesity, inpatient status prior to procedure, Black or White race, chronic steroid use, smoking, diabetes, and hypertension.
These findings may be used to individualize preoperative discussions and help guide optimization of risk factors. In addition, while autologous reconstruction and implant-based reconstruction are often combined into one category for discussion of factors that increase complication risk, our study suggests that the types of reconstruction differ with regard to the comorbidities that increase risk for hospital readmission.
影响伤口愈合、增加感染风险并损害组织活力的合并症会影响自体乳房重建和植入式乳房重建后的医院再入院率。本研究旨在评估自体乳房重建和植入式乳房重建后30天内医院再入院风险增加的患者因素，并确定每种方法后影响再入院风险的合并症差异。
从美国外科医师学会国家外科质量改进计划数据库中，通过自体乳房重建和植入式乳房重建的当前手术操作术语代码选择2005年至2021年的患者。多变量回归模型确定了计划外再入院的显著预测因素。
增加自体乳房重建后而非植入式乳房重建后再入院风险的合并症包括透析（比值比3.87，p = 0.042）和营养不良（比值比3.20，p = 0.003）。增加植入式乳房重建后而非自体乳房重建后再入院风险的因素包括出血性疾病（比值比2.62，p < 0.0001）、既往感染（比值比1.49，p = 0.045）、近期脓毒症（比值比2.16，p = 0.0003）、贫血（比值比1.13，p = 0.0018）和低白蛋白血症（比值比1.35，p = 0.0213）。两种方法后计划外再入院的预测因素包括慢性阻塞性肺疾病、肥胖、手术前的住院状态、黑人或白人种族、长期使用类固醇、吸烟、糖尿病和高血压。
这些发现可用于个体化术前讨论，并有助于指导风险因素的优化。此外，虽然自体乳房重建和植入式乳房重建在讨论增加并发症风险的因素时通常合并为一类，但我们的研究表明，在增加医院再入院风险的合并症方面，重建类型有所不同。
