Page 58 - Read Online

Page 10 of 17 Plast Aesthet Res 2018;5:6 I http://dx.doi.org/10.20517/2347-9264.2018.08

Results: The cohort was composed of 23 and 21 consecutive patients who underwent DIEP flap breast
reconstruction before and after the institution of an ERAS protocol respectively. A total of 73 flaps were
performed (37 and 36 flaps before and after ERAS respectively). LOS decreased from 4.82 ± 0.77 to 3
± 0 after the institution of the ERAS protocol. Of the ERAS patients, 42 % did not take narcotics after
discharge; the remainder of the group was on narcotics for 5.3 days on average (range 2-14 days). Operative
times were on average 4.67 and 7.4 h for unilateral and bilateral procedures. Complications were similar in
both cohorts.

Conclusion: The addition of an ERAS protocol to a two-team approach leads to a significant decrease in LOS
and minimizes postoperative narcotic use after microsurgical breast reconstruction.

16. An evaluation of infection related readmissions after breast reconstructive surgery
using the Nationwide Readmissions Database

Willem Collier, Melody Scheefer, Jaewhan Kim, Alvin Kwok

University of Utah

Aim: Hospital readmissions are costly. Thirty-day postoperative readmission rates are a common quality
metric with associated financial consequences. Little is known about readmission rates for infection after
implant-based breast reconstruction. We used the Nationwide Readmissions Database (NRD) to determine
the rate and predictors of early and late hospital readmissions associated with infection after implant-based
breast reconstruction.

Methods: Using the 2013-2014 NRD, we identified breast cancer patients undergoing implant-based breast
reconstruction who had an infectious readmission with ICD-9 diagnosis and procedure codes. We used
univariate and multivariate logistic regression models to identify patient demographic, comorbidity, and
hospital predictors of infectious readmission within the early (0-30 day) and late (31-90 day) postoperative
time-periods.

Results: In a weighted sample of the NRD, we identified 18,338 patients who underwent implant-based
breast reconstruction. The overall infectious readmission rate for this group was 5.3%. Only 38.4%
of such readmissions occurred within the initial 30 days after surgery, and 39.5% occurred 31-90
days after surgery. Medicaid patients (OR 1.45, P = 0.035), median annual household income < $40,000 (OR
1.41, P = 0.023), diabetes (OR 1.52, P = 0.030), and obesity (OR 1.54, P = 0.021) were independent predictors
of overall infectious readmission. Only diabetes (OR 1.74, P = 0.041) was an independent predictor of early
infectious readmissions. Medicaid (OR 1.74, P = 0.033), median annual household income < $40,000 (OR
1.66, P = 0.030), obesity (OR 1.94, P = 0.007), and length of hospital stay during the index procedure (OR 1.09,
P = 0.028) were independent predictors of late infectious readmission.

Conclusion: Readmissions for infectious reasons after implant-based breast reconstruction occur more
frequently beyond the initial 30-day postoperative period. Traditional thirty-day readmission rates may not
be an adequate quality metric for breast reconstruction given the number of late postoperative readmissions.
Early and late infectious readmissions have different predictors. Interventions targeting these predictors may
decrease the number of readmissions.