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Factors Associated with Readmission following Plastic Surgery: A Review of 10,669 Procedures from the 2011 American College of Surgeons National Surgical Quality Improvement Program Data Set

Fischer, John P. M.D.; Wes, Ari M. B.A.; Nelson, Jonas A. M.D.; Serletti, Joseph M. M.D.; Kovach, Stephen J. M.D.

Plastic & Reconstructive Surgery: September 2013 - Volume 132 - Issue 3 - p 666–674
doi: 10.1097/PRS.0b013e31829acc8c
Reconstructive: Trunk: Outcomes Article
Press Release

Background: This study explored factors associated with readmission following plastic surgery using a prospective, validated, national database.

Methods: Patients who underwent primary plastic surgery procedures (n = 10,669) were identified from the 2011 American College of Surgeons National Surgical Quality Improvement Program databases. Those who were readmitted were compared with those who were not. Preoperative patient comorbidities, laboratory values, and intraoperative details derived from the data set were analyzed, and multivariate regression analysis was used to identify predictors of readmission.

Results: A total of 10,669 patients were included, with a 4.5 percent readmission rate. Their average age was 49.5 years, 32.2 percent were obese, 15.2 percent were smokers, and 81.7 percent were women. The most commonly performed procedures included elective/cosmetic breast (23.4 percent), implant breast reconstruction (16.5 percent), revision breast procedures (14.9 percent), hand operations (9.7 percent), and body contouring (5.9 percent). The wound complication rate was 4.6 percent and the medical complication rate was 4.9 percent. The overall incidence of any postoperative complication was 10.9 percent, of which 4.8 percent were defined as major surgical complications. Independent risk factors associated with readmission included procedure type (p = 0.029); obesity (p = 0.011); anemia (p = 0.003); and medical (p < 0.001), major surgical (p < 0.001), and wound (p < 0.001) complications.

Conclusions: The most significant predictor of readmission was postoperative complications. Patients experiencing postoperative surgical complications were six times more likely to be readmitted. These findings can assist surgeons and health systems to better tailor preoperative risk counseling, resource allocation, and postoperative discharge services.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Philadelphia, Pa.

From the Division of Plastic Surgery, Hospital of the University of Pennsylvania.

Received for publication February 22, 2013; accepted March 19, 2013.

Disclosure: The authors report no relevant financial disclosures related to this current work. This particular research received no internal or external grant funding.

John P. Fischer, M.D., Division of Plastic Surgery, University of Pennsylvania, 3400 Spruce Street, Philadelphia, Pa. 19104, john.fischer2@uphs.upenn.edu

©2013American Society of Plastic Surgeons