The National Surgical Quality Improvement Program 30-Day Challenge: Microsurgical Breast Reconstruction Outcomes Reporting Reliability

Austin D. Chen; Parisa Kamali, MD; Anmol S. Chattha, BA; Alexandra Bucknor, MBBS, MSc; Justin B. Cohen, MD, MHS; Patrick P. Bletsis, BSc; Renata Flecha-Hirsch, BA; Adam M. Tobias, MD; Bernard T. Lee, MD, MBA, MPH; Samuel J. Lin, MD, MBA

doi:10.1097/GOX.0000000000001643

Plastic and Reconstructive Surgery, Global Open (Mar 2018)

The National Surgical Quality Improvement Program 30-Day Challenge: Microsurgical Breast Reconstruction Outcomes Reporting Reliability

Austin D. Chen,
Parisa Kamali, MD,
Anmol S. Chattha, BA,
Alexandra Bucknor, MBBS, MSc,
Justin B. Cohen, MD, MHS,
Patrick P. Bletsis, BSc,
Renata Flecha-Hirsch, BA,
Adam M. Tobias, MD,
Bernard T. Lee, MD, MBA, MPH,
Samuel J. Lin, MD, MBA

Affiliations

Austin D. Chen: From the *Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.; and †Department of Plastic, Reconstructive and Hand Surgery, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands.
Parisa Kamali, MD: From the *Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.; and †Department of Plastic, Reconstructive and Hand Surgery, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands.
Anmol S. Chattha, BA: From the *Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.; and †Department of Plastic, Reconstructive and Hand Surgery, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands.
Alexandra Bucknor, MBBS, MSc: From the *Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.; and †Department of Plastic, Reconstructive and Hand Surgery, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands.
Justin B. Cohen, MD, MHS: From the *Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.; and †Department of Plastic, Reconstructive and Hand Surgery, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands.
Patrick P. Bletsis, BSc: From the *Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.; and †Department of Plastic, Reconstructive and Hand Surgery, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands.
Renata Flecha-Hirsch, BA: From the *Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.; and †Department of Plastic, Reconstructive and Hand Surgery, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands.
Adam M. Tobias, MD: From the *Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.; and †Department of Plastic, Reconstructive and Hand Surgery, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands.
Bernard T. Lee, MD, MBA, MPH: From the *Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.; and †Department of Plastic, Reconstructive and Hand Surgery, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands.
Samuel J. Lin, MD, MBA: From the *Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.; and †Department of Plastic, Reconstructive and Hand Surgery, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands.

DOI: https://doi.org/10.1097/GOX.0000000000001643
Journal volume & issue: Vol. 6, no. 3
p. e1643

Abstract

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Background:. The aim was to assess reliability of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) 30-day perioperative outcomes and complications for immediate, free-tissue transfer breast reconstruction by direct comparisons with our 30-day and overall institutional data, and assessing those that occur after 30 days. Methods:. Data were retrieved for consecutive immediate, free-tissue transfer breast reconstruction patients from a single-institution database (2010–2015) and the ACS-NSQIP (2011–2014). Multiple logistic regressions were performed to compare adjusted outcomes between the 2 datasets. Results:. For institutional versus ACS-NSQIP outcomes, there were no significant differences in surgical-site infection (SSI; 30-day, 3.6% versus 4.1%, P = 0.818; overall, 5.3% versus 4.1%, P = 0.198), wound disruption (WD; 30-day, 1.3% versus 1.5%, P = 0.526; overall, 2.3% versus 1.5%, P = 0.560), or unplanned readmission (URA; 30-day, 2.3% versus 3.3%, P = 0.714; overall, 4.6% versus 3.3%, P = 0.061). However, the ACS-NSQIP reported a significantly higher unplanned reoperation (URO) rate (30-day, 3.6% versus 9.5%, P < 0.001; overall, 5.3% versus 9.5%, P = 0.025). Institutional complications consisted of 5.3% SSI, 2.3% WD, 5.3% URO, and 4.6% URA, of which 25.0% SSI, 28.6% WD, 12.5% URO, and 7.1% URA occurred at 30–60 days, and 6.3% SSI, 14.3% WD, 18.8% URO, and 42.9% URA occurred after 60 days. Conclusion:. For immediate, free-tissue breast reconstruction, the ACS-NSQIP may be reliable for monitoring and comparing SSI, WD, URO, and URA rates. However, clinicians may find it useful to understand limitations of the ACS-NSQIP for complications and risk factors, as it may underreport complications occurring beyond 30 days.

Published in Plastic and Reconstructive Surgery, Global Open

ISSN: 2169-7574 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://www.prsgo.com

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