Unplanned 180-day Readmissions and Health Care Utilization after Immediate Breast Reconstruction for Breast Cancer

Arturo J. Rios-Diaz; Theodore E. Habarth-Morales; Emily L. Isch; Chris Amro; Harrison D. Davis; Robyn B. Broach; Matthew Jenkins; John P. Fischer; Joseph M. Serletti

doi:10.1055/a-2460-4821

Journal of Reconstructive Microsurgery, Inhaltsverzeichnis

J Reconstr Microsurg 2025; 41(07): 575-585
DOI: 10.1055/a-2460-4821

Original Article

Unplanned 180-day Readmissions and Health Care Utilization after Immediate Breast Reconstruction for Breast Cancer

Arturo J. Rios-Diaz^*

¹Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania

,

Theodore E. Habarth-Morales^*

¹Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania

²Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania

,

Emily L. Isch

³Division of Plastic Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania

,

Chris Amro

⁴Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey

,

Harrison D. Davis

¹Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania

⁵Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania

,

Robyn B. Broach

¹Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania

,

Matthew Jenkins

³Division of Plastic Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania

,

John P. Fischer

¹Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania

,

Joseph M. Serletti

¹Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania

› Institutsangaben

Abstract

Background

To assess the burden of postdischarge health care utilization given by readmissions beyond 30 days following immediate breast reconstruction (IBR) nationwide.

Methods

Women with breast cancer who underwent mastectomy and concurrent IBR (autologous and implant-based) were identified within the 2010 to 2019 Nationwide Readmission Database. Cox proportional hazards and generalized linear regression controlling for patient- and hospital-level confounders were used to determine factors associated with 180-day unplanned readmissions and incremental hospital costs, respectively.

Results

Within 180 days, 10.7% of 100,942 women were readmitted following IBR. Readmissions tended to be publicly insured (30.8 vs. 21.7%, p < 0.001) and multimorbid (Elixhauser Comorbidity Index > 2 31.6 vs. 19.6%, p < 0.001) compared with nonreadmitted patients. There were no differences in readmission rates among types of IBR (tissue expander 11.2%, implant 10.7%, autologous 10.8%; p > 0.69). Of all readmissions, 40% occurred within 30 days and 21.7% in a different hospital and 40% required a major procedure in the operating room. Infection was the leading cause of readmissions (29.8%). In risk-adjusted analyses, patients with carcinoma in situ, publicly insured, low socioeconomic status, and higher comorbidity burden were associated with increased readmissions (all p < 0.05). Readmissions resulted in additional $8,971.78 (95% confidence interval: $8,537.72–9,405.84, p < 0.001) in hospital costs, which accounted for 15% of the total cost of IBR nationwide.

Conclusion

The majority of inpatient health care utilization given by readmissions following mastectomy and IBR occurs beyond the 30-day benchmark. There is evidence of fragmentation of care as a quarter of readmissions occur in a different hospital and over one-third require major procedures. Mitigating postoperative infectious complications could result in the highest reduction of readmissions.

Keywords

breast cancer - mastectomy - immediate breast reconstruction - unplanned readmission - costs - epidemiology - health care utilization - nationwide

Volltext

Referenzen

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