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Predictors of Readmission after Outpatient Plastic Surgery

Mioton, Lauren M. B.S.; Buck, Donald W. II M.D.; Rambachan, Aksharananda B.A.; Ver Halen, Jon M.D.; Dumanian, Gregory A. M.D.; Kim, John Y. S. M.D.

Plastic & Reconstructive Surgery:
doi: 10.1097/01.prs.0000436833.11442.8d
Special Topics
Abstract

Background: Hospital readmissions have become a topic of focus for quality care measures and cost-reduction efforts. However, no comparative multi-institutional data on plastic surgery outpatient readmission rates currently exist. The authors endeavored to investigate hospital readmission rates and predictors of readmission following outpatient plastic surgery.

Methods: The 2011 National Surgical Quality Improvement Program database was reviewed for all outpatient procedures. Unplanned readmission rates were calculated for all 10 tracked surgical specialties (i.e., general, thoracic, vascular, cardiac, orthopedics, otolaryngology, plastics, gynecology, urology, and neurosurgery). Multivariate logistic regression models were used to determine predictors of readmission for plastic surgery.

Results: A total of 7005 outpatient plastic surgery procedures were isolated. Outpatient plastic surgery had a low associated readmission rate (1.94 percent) compared with other specialties. Seventy-five patients were readmitted with a complication. Multivariate regression analysis revealed obesity (body mass index ≥30), wound infection within 30 days of the index surgery, and American Society of Anesthesiologists class 3 or 4 physical status as significant predictors for unplanned readmission.

Conclusions: Unplanned readmission after outpatient plastic surgery is infrequent and compares favorably to rates of readmission among other specialties. Obesity, wound infection within 30 days of the index operation, and American Society of Anesthesiologists class 3 or 4 physical status are independent predictors of readmission. As procedures continue to transition into outpatient settings and the drive to improve patient care persists, these findings will serve to optimize outpatient surgery use.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Author Information

Nashville and Memphis, Tenn.; and Chicago, Ill.

From the Vanderbilt School of Medicine; the Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine; and the Department of Plastic and Reconstructive Surgery, University of Tennessee.

Received for publication March 14, 2012; accepted May 14, 2013.

Disclosure: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this article.

John Y. S. Kim, M.D., Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, 675 North St. Clair Street, Galter Suite 19-250, Chicago, Ill. 60611, jokim@nmh.org

©2014American Society of Plastic Surgeons