Trends in Microvascular Breast Reconstruction: An Evaluation of 8,561 Cases in the ACS National Surgical Quality Improvement Program Database

Abstract

Purpose: Since 2012, there has been a 7-fold increase in the number of publications per year pertaining to enhanced recovery after surgery protocols for reconstructive surgery. We hypothesize that for breast reconstruction, the national average length of stay (LOS) has decreased since 2012 without adverse effects on national complication and readmission rates. Methods: We identified female patients who have undergone microvascular breast reconstruction (CPT 19364) from the 2012-2017 ACS National Surgical Quality Improvement Program database. Trends in complication and readmission rates, and LOS were examined over the 6-year period. Multivariate logistic regression models were used to evaluate associations between LOS and readmission rates. Results: 8,561 cases were identified. LOS significantly decreased from 2012-2017 (4.4, 4.2, 4.2, 4.1, 4.0, 3.9 days respectively) (p<0.001). We observed significantly decreased major complication rates from 26.1% to 20.0% (p=0.001). Thirty-day readmission rates remained statistically consistent over the study period from 6.7% to 6.0%. The most common reason for readmission was surgical site infection. For each additional day of LOS, there was 47% increase in odds of complications (OR 1.47, 95% CI: 1.42 to 1.52) and 20% increase in odds of readmissions (OR 1.2, 95% CI: 1.10 to 1.21). Conclusions: Using a national sample from 2012-2017, we observed a significant decrease in LOS for patients undergoing microvascular breast reconstruction. While LOS decreased nationally, we observed a significant decrease in complication rates over the study period but no significant change in readmission rates. Current efforts to reduce LOS are performed safely without increased complication or readmission rates.