Increased hospital volume is associated with improved outcomes following abdominal-based breast reconstruction. Issue 6 (December 2014)

• Record Type: Journal Article
• Authors: Tuggle, Charles T.; Patel, Anup; Broer, Niclas; Persing, John A.; Sosa, Julie A.; Au, Alexander F.
• Is Part Of: Journal of plastic surgery and hand surgery. Volume 48:Issue 6(2014)
• Page Start: 382
• Page End: 388
• Publication Date: 2014-12
• Subjects: Surgery -- Periodicals; Hand -- Surgery -- Periodicals; Orthopedics -- Periodicals; Surgery, Plastic -- Periodicals; 617.95
• DOI: 10.3109/2000656X.2014.899241
• Languages: English
• ISSNs: 2000-656X

Abstract

<abstract> <title>Abstract</title> <p>Previous studies of outcomes following abdominal-based breast reconstruction largely use data from single-centre/surgeon experience. Such studies are limited in evaluating the effect of operative volume on outcomes. Abdominal-based breast reconstructive procedures were identified in the 2009–2010 HCUP Nationwide Inpatient Sample. Outcomes included in-hospital microvascular complications in free flap cases (requiring exploration/anastomosis revision), procedure-related and total complications in all cases, and length of stay (LOS). High-volume hospitals were defined as 90th percentile of case volume or higher (>30 flaps/year). Univariate and multivariate analyses were performed to identify predictors of outcomes. Of the 4107 patients identified, mean age was 50.7 years; 71% were white, 68% underwent free flap reconstruction, and 25% underwent bilateral reconstruction. The total complication rate was 13.2%, and the microvascular complication rate was 7.0%. Mean LOS was 4.5 days. There were 436 hospitals; 59% of cases were performed at high-volume institutions. Patients at high-volume hospitals more often underwent free flap reconstruction compared to low-volume hospitals (82.4% vs 50.5%, <italic>p</italic> < 0.001). On unadjusted analysis, microvascular complication rates of 6.4% vs 8.2% were observed for high-volume compared to low-volume hospitals (<italic>p</italic> = 0.080). After adjusting for case-mix, high-volume hospitals were associated with a decreased likelihood of suffering a microvascular complication (OR = 0.71, <italic>p</italic> = 0.026), procedure-related complication (OR = 0.79, <italic>p</italic> = 0.033), or total complication (OR = 0.75, <italic>p</italic> = 0.004). The majority of cases nationwide are performed at a small number of high-volume hospitals. These hospitals appear to discharge patients earlier and have lower microvascular, procedure-related, and total complication rates when controlling for case-mix.</p> </abstract>