"A Critical Examination of Length of Stay in Autologous Breast Reconstruction: A NSQIP Analysis".

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Citation: Plastic & Reconstructive Surgery. 2020 Sep 28PMID: 33002979Institution: MedStar Washington Hospital Center | MedStar Washington Hospital Center IDepartment: Surgery/Plastic SurgeryForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: IN PROCESS -- NOT YET INDEXEDYear: 2020ISSN:
  • 0032-1052
Name of journal: Plastic and reconstructive surgeryAbstract: BACKGROUND: This study aims to use the National Surgical Quality Improvement Program (NSQIP) database to identify factors associated with extended postoperative length of stay (LOS) after breast reconstruction with free tissue transfer (FTT).CONCLUSION: This study characterizes the risks for extended length of stay after free tissue transfer breast reconstruction using a prospective multicenter national database. The result of this study can be used to risk-stratify patients during surgical planning to optimize perioperative decision making.METHODS: Consecutive cases of breast reconstruction with free tissue transfer were retrieved from the NSQIP (2005-2017) database using Current Procedural Terminology (CPT) code 19364. Extended LOS (dependent variable) was defined as > 5 days.RESULTS: 9,686 cases were analyzed; extended LOS was noted in 34%. On regression, patient factors independently associated with extended LOS were BMI (OR 1.5, 95% CI 1.2-1.9, p<0.001), diabetes (OR 1.3, 95% CI 1.1-1.6, p=0.003), and malignancy history (OR 1.9, 95% CI 1.22.-3.02, p=0.005). Operation time > 500 minutes (OR 3, 95% CI 2.73-3.28, p<0.001) and immediate postmastectomy reconstruction (OR 1.7, 95% CI 1.16-2.48, p<0.001) conferred risk for extended LOS. Bilateral FTT was not significant. Operations performed in 2017 were at lower risk (OR 0.2, 95% CI 0.06-0.81, p=0.02) for extended LOS. Reoperation is more likely following operative transfusion and bilateral FTTs, but less likely following concurrent alloplasty. Given a known operation time (minutes), postoperative LOS (days) can be calculated using the equation: LOS = 2.559 + 0.003*operation time.All authors: Abadeer AI, Amdur RL, Fan KL, Kotha VS, Song DHFiscal year: FY2021Digital Object Identifier: Date added to catalog: 2020-12-29
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Journal Article MedStar Authors Catalog Article 33002979 Available 33002979

BACKGROUND: This study aims to use the National Surgical Quality Improvement Program (NSQIP) database to identify factors associated with extended postoperative length of stay (LOS) after breast reconstruction with free tissue transfer (FTT).

CONCLUSION: This study characterizes the risks for extended length of stay after free tissue transfer breast reconstruction using a prospective multicenter national database. The result of this study can be used to risk-stratify patients during surgical planning to optimize perioperative decision making.

METHODS: Consecutive cases of breast reconstruction with free tissue transfer were retrieved from the NSQIP (2005-2017) database using Current Procedural Terminology (CPT) code 19364. Extended LOS (dependent variable) was defined as > 5 days.

RESULTS: 9,686 cases were analyzed; extended LOS was noted in 34%. On regression, patient factors independently associated with extended LOS were BMI (OR 1.5, 95% CI 1.2-1.9, p<0.001), diabetes (OR 1.3, 95% CI 1.1-1.6, p=0.003), and malignancy history (OR 1.9, 95% CI 1.22.-3.02, p=0.005). Operation time > 500 minutes (OR 3, 95% CI 2.73-3.28, p<0.001) and immediate postmastectomy reconstruction (OR 1.7, 95% CI 1.16-2.48, p<0.001) conferred risk for extended LOS. Bilateral FTT was not significant. Operations performed in 2017 were at lower risk (OR 0.2, 95% CI 0.06-0.81, p=0.02) for extended LOS. Reoperation is more likely following operative transfusion and bilateral FTTs, but less likely following concurrent alloplasty. Given a known operation time (minutes), postoperative LOS (days) can be calculated using the equation: LOS = 2.559 + 0.003*operation time.

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