Unplanned reoperations after microsurgical breast reconstruction: Findings from the American College of Surgeons National Surgical Quality Improvement Program.

Abstract

BACKGROUND\nWhile microsurgical breast reconstruction may require multiple planned operations, unplanned reoperations has not been studied. We sought to investigate unplanned reoperations after microsurgical breast reconstruction.\n\n\nMETHODS\nWe queried the American College of Surgeons National Surgical Quality Improvement Program between 2005 and 2018. Current Procedural Terminology code 19364 was used to identify all patients with microsurgical breast reconstruction. Patient demographics, medical comorbidities, preoperative laboratory results, and operative data were analyzed. The primary outcome measure was 30-day unplanned reoperation.\n\n\nRESULTS\nOf 8449 patients meeting inclusion criteria, 1021 required an unplanned reoperation (12.1%). These patients were more likely to be obese, smokers, hypertensive, on steroids preoperatively, needing concomitant mastectomy, and with prolonged operating room time >9\u2009h (p\u2009<\u2009.05). Multivariable regression model revealed preoperative steroids intake (OR\xa0=\xa01.92, CI 1.09-3.38, p\xa0=\xa0.03), concomitant mastectomy (OR\xa0=\xa01.45, CI 1.23-1.71, p\u2009<\u2009.01), and operating room time >9\u2009h (OR\xa0=\xa01.37, CI 1.16-1.62, p\u2009<\u2009.01) as independent risk factors. Mastectomy was found to be an independent risk factor for early reoperation, that is, ≤2\u2009days (OR\xa0=\xa01.44, CI 1.14-1.82, p\u2009<\u2009.01), whereas obesity was an independent risk factor for three reoperations (OR\xa0=\xa03.92, CI 1.14-13.46, p\xa0=\xa0.03).\n\n\nCONCLUSION\nUnplanned reoperations within 30-days after microsurgical breast reconstruction are a significant problem. Mastectomy is an independent risk factor for early reoperation whereas obesity is an independent risk factor for multiple reoperations. Identification of such patients preoperatively may help microsurgeons improve patient safety and quality of care.