Aim: Hospital readmissions are costly. Thirty-day postoperative readmission rates are a common quality metric with associated financial consequences. Little is known about readmission rates for infection after implant-based breast reconstruction. We used the Nationwide Readmissions Database (NRD) to determine the rate and predictors of early and late hospital readmissions associated with infection after implant-based breast reconstruction.
Methods: Using the 2013-2014 NRD, we identified breast cancer patients undergoing implant-based breast reconstruction who had an infectious readmission with ICD-9 diagnosis and procedure codes. We used univariate and multivariate logistic regression models to identify patient demographic, comorbidity, and hospital predictors of infectious readmission within the early (0-30 day) and late (31-90 day) postoperative time-periods.
Results: In a weighted sample of the NRD, we identified 18,338 patients who underwent implant-based breast reconstruction. The overall infectious readmission rate for this group was 5.3%. Only 38.4% of such readmissions occurred within the initial 30 days after surgery, and 39.5% occurred 31-90 days after surgery. Medicaid patients (OR 1.45, P = 0.035), median annual household income < $40,000 (OR 1.41, P = 0.023), diabetes (OR 1.52, P = 0.030), and obesity (OR 1.54, P = 0.021) were independent predictors of overall infectious readmission. Only diabetes (OR 1.74, P = 0.041) was an independent predictor of early infectious readmissions. Medicaid (OR 1.74, P = 0.033), median annual household income < $40,000 (OR 1.66, P = 0.030), obesity (OR 1.94, P = 0.007), and length of hospital stay during the index procedure (OR 1.09, P = 0.028) were independent predictors of late infectious readmission.
Conclusion: Readmissions for infectious reasons after implant-based breast reconstruction occur more frequently beyond the initial 30-day postoperative period. Traditional thirty-day readmission rates may not be an adequate quality metric for breast reconstruction given the number of late postoperative readmissions. Early and late infectious readmissions have different predictors. Interventions targeting these predictors may decrease the number of readmissions.