In-hospital Complications In Breast Reconstruction Admission: An Analysis Of 7438 Patients
Lior Levy, BA1, Abbas Smiley, MD, PHD2, Helen Perakis, MD, MHA2, Logan Carr, MD2, Edmond Ritter, MD2.
1New York Medical College, Valhalla, NY, USA, 2Westchester Medical Center, Valhalla, NY, USA.
Purpose: Autologous breast reconstructions are often challenging and these patients sometimes sustain complications during their admission stay. The goal of our study was to assess risk factors for in-hospital complications, morbidity, and mortality in these patients. Methods: Breast reconstruction patients were admitted and analyzed using the National Inpatient Sample database, 2005-2014. Demographics, clinical data, and outcomes were gathered. The relationships between complications, morbidity, mortality, and the predictors were assessed using a multivariable logistic regression model. Results: 7,438 patients were analyzed. The mean age was 52. The patients were classified based on type of autologous reconstruction: free flap (62.7%) or pedicled flap (37.3%). The mean hospital length of stay (HLOS) was 3.37 days in patients who underwent pedicled flaps and 3.12 days for free flaps. The mean modified frailty index score was significantly higher (0.79) in patients reconstructed with pedicled flaps versus free flaps (0.54). 6.2% of all cases manifested complications which were significantly positively correlated to comorbidities such as obesity, diabetes, hypertension, heart disease, peripheral vascular disease, renal failure, depression, and deficiency anemia. Additionally, the patients with these comorbidities demonstrated higher HLOS, 5.73 vs. 2.98 days (p<0.001) and reoperation rate 1.5% vs. 0.3% (p<0.001). Conclusion: Comorbidities were independent predictors of in-hospital complications for patients undergoing autologous breast reconstruction. Patients with these comorbidities manifested higher rates of reoperation and HLOS regardless of the type of autologous reconstruction. Stratifying patients utilizing these comorbidities and the modified frailty index score may be helpful in predicting in-hospital complications for patients undergoing autologous breast reconstruction.
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