The Association Of Overall Annual Hospital Volume On Outcomes Following Free Flap Breast Reconstruction
Ronnie L. Shammas, Jr., M.D., Yi Ren, MS, Samantha M. Thomas, MS, Brett T. Phillips, M.D., MBA, Rachel A. Greenup, M.D., MPH, Scott T. Hollenbeck, M.D..
Duke University Health System, Durham, NC, USA.
PURPOSE
Hospital volume has been demonstrated to correlate with improvements in complex surgical procedures and cancer outcomes. Subspecialty training and coordination of care are required for successful free flap breast reconstruction after mastectomy. We determined the effect of overall hospital volume on outcomes following free flap breast reconstruction.
METHODS
Breast reconstruction patients were identified using the HCUP-NIS (2012-2016) database. Logistic regression with restricted cubic splines (RCS) characterized the association of hospital volume (discharges/year) with systemic, surgical, and microsurgical complications. Patients were categorized as being treated at low vs. high-volume hospitals based on identified threshold volumes, and the association of these volumes with the incidence of complications was estimated.
RESULTS
Overall, 7,991 patients underwent breast reconstruction at 1,907 centers. RCS analysis suggested that at threshold volumes of 13,018 (95% CI:7,468-14,512) and 7,091 (95% CI:5,396–9,918) discharges/year, the risk for developing systemic and microsurgical complications increased, respectively. There was no association between overall annual hospital volume and surgical complications. Patients were then dichotomized into treatment groups at low versus high-volume facilities based on the threshold volumes. Examination of this association on the patient level revealed that treatment at low versus high-volume facilities did not independently predict the risk of developing systemic or microsurgical complications.
CONCLUSION
The risk of complications related to free flap breast reconstruction did not differ between patients treated at low vs. high-volume hospitals. Patient outcomes are more likely associated with surgeon experience, and overall annual hospital volume should not serve as a proxy for the quality of breast reconstruction.
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