Risk of Readmission following Immediate Breast Reconstruction: Results from the 2011 American College of Surgeons National Surgical Quality Improvement Program Data Sets

Background: 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. Methods: 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. Results: 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/m(2); 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. Conclusions: 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.