National Trends in Length of Stay for Microvascular Breast Reconstruction: An Evaluation of 10,465 Cases Using the American College of Surgeons National Surgical Quality Improvement Program Database.

Autor:	Holoyda KA; From the Department of Surgery, Division of Plastic Surgery, and Department of Population Health Sciences, University of Utah School of Medicine., Magno-Padron DA; From the Department of Surgery, Division of Plastic Surgery, and Department of Population Health Sciences, University of Utah School of Medicine., Carter GC; From the Department of Surgery, Division of Plastic Surgery, and Department of Population Health Sciences, University of Utah School of Medicine., Agarwal JP; From the Department of Surgery, Division of Plastic Surgery, and Department of Population Health Sciences, University of Utah School of Medicine., Kwok AC; From the Department of Surgery, Division of Plastic Surgery, and Department of Population Health Sciences, University of Utah School of Medicine.
Jazyk:	angličtina
Zdroj:	Plastic and reconstructive surgery [Plast Reconstr Surg] 2022 Feb 01; Vol. 149 (2), pp. 306-313.
DOI:	10.1097/PRS.0000000000008706
Abstrakt:	Background: Decreasing length of stay benefits patients and hospital systems alike. This should be accomplished safely without negatively impacting patient outcomes. The authors hypothesize that in the United States, the average length of stay for patients undergoing microsurgical breast reconstruction has decreased since 2012 without a concurrent increase in complication and readmission rates. Methods: The authors identified female patients who underwent microvascular breast reconstruction (CPT 19364) from the 2012 to 2018 National Surgical Quality Improvement Program database. Trends in complication and readmission rates and length of stay were examined over 7 years. Multivariable logistic regression models and Mann-Kendall trend tests were used to evaluate associations between length of stay and complication and readmission rates. Results: A total of 10,465 cases were identified. The number of autologous microvascular breast reconstruction procedures performed increased annually between 2012 and 2018. Length of stay decreased significantly from 2012 to 2018 (from 4.47 days to 3.90 days) (p < 0.01). Minor and major complication rates remained constant, although major complications showed a decreasing trend (from 27 percent to 21 percent) (p = 0.07). Thirty-day readmission, surgical-site infection, and wound dehiscence rates remained consistent over the study period, whereas rates of blood transfusion or bleeding decreased (p = 0.02). Conclusions: Using a national sample from 2012 to 2018, the authors observed a significant decrease in length of stay for patients undergoing microvascular breast reconstruction without a concurrent increase in complication and readmission rates. Current efforts to reduce length of stay have been successful without increasing complication or readmission rates. Clinical Question/level of Evidence: Risk, III. (Copyright © 2021 by the American Society of Plastic Surgeons.)
Databáze:	MEDLINE
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