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Variation in Hospital-Based Acute Care within 30 Days of Outpatient Plastic Surgery

Hansen, Dallas G. M.D.; Abbott, Lindsay E. M.D.; Johnson, R. Michael M.D.; Fox, Justin P. M.D., M.H.S.

Plastic and Reconstructive Surgery: September 2014 - Volume 134 - Issue 3 - p 370e–378e
doi: 10.1097/PRS.0000000000000442
Cosmetic: Outcomes Article

Background: When complications arise following outpatient plastic surgery, patients may require hospital-based acute care after discharge. The extent to which these events vary across centers may reflect the quality of care provided. The authors conducted this study to describe the frequency and variation of hospital-based acute care rates across ambulatory surgery centers.

Methods: From the 2009 to 2010 California, Florida, Nebraska, and New York ambulatory surgery databases, the authors identified adult patients who underwent common outpatient plastic surgery procedures between July of 2009 and September of 2010. Hospital-based acute care was defined as any emergency department visit or hospital admission within 30 days of discharge. Performance across centers was assessed by calculating observed-to-expected ratios derived from multivariable logistic regression models.

Results: The authors identified 72,308 discharges from 519 centers. Most were female patients (80.9 percent); self-pay patients (41.5 percent); and underwent blepharoplasty (36.9 percent), breast augmentation (14.2 percent), or multiple procedures (12.2 percent). The observed hospital-based, acute care rate was 42.8 encounters per 1000 discharges, with most managed in the emergency department for symptoms or complications of care. The median charges associated with these encounters were $2183 and $26,299 for emergency department visits and hospital admissions, respectively. Wide variation was noted in hospital-based acute care rates, with 15 centers (2.9 percent) performing significantly better and 27 (5.2 percent) performing significantly worse than expected after adjusting for case mix.

Conclusions: The overall rate of hospital-based acute care after common outpatient plastic surgery procedures is low but measurable. However, the frequency of these events varies across centers and may reflect the quality of care provided.

Dayton, Ohio

From the Department of Surgery and the Department of Orthopedics, Division of Plastic Surgery, Boonshoft School of Medicine, Wright State University.

Received for publication December 4, 2013; accepted January 23, 2014.

Presented in part at the 56th Annual Meeting of the Ohio Valley Society of Plastic Surgeons, in Indianapolis, Indiana, May 17 through 19, 2013.

Disclaimer: The views expressed in this article are those of the authors and do not reflect the official policy of the U.S. Air Force, Department of Defense, or the U.S. Government.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Dallas G. Hansen, M.D., Miami Valley Hospital, One Wyoming Street, Suite 7000 WCHE, Dayton, Ohio 45409,

©2014American Society of Plastic Surgeons