The Underlying Reasons and Timing for Readmission in Plastic Surgery Procedures
Jordan T. Blough, B.S., Nima Khavanin, B.S., Mohammed S. Alghoul, M.D., John Y. Kim, M.D..
Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Risk factors for readmission are well-known in plastic surgery, but the underlying reasons and timing of these events have yet to be investigated.
Data from the National Surgical Quality Improvement Program (2012-2013) regarding the underlying reasons for readmission in Plastic surgery procedures were consolidated into 17 categories. The incidence, timing, and reasons for readmission were analyzed for the overall cohort and common, individual procedures. Kaplan-Meier survival curves were developed for readmission events, and median days to readmission were calculated for each underlying reason (See Figure).
Overall, 1,267 (3.8%) of 33,021 patients were readmitted. Of these, 17.7% (n=206) were unrelated to the index operation. SSI was the most common reason for readmission (n=310, 26.7%), followed by hematoma/hemorrhage (n=101, 8.7%;), prosthesis-related complications (n=77, 6.6%), surgical complications (n=72, 6.2%), and wound disruption (n=71, 6.1%). Reasons varied by procedure type, but SSI was consistently the most frequent reason. Readmission risk is highest immediately following discharge and progressively tapers by 30 days. The most common early drivers of readmission included hemorrhage, hematoma, and GI complications; late drivers were SSI, sepsis, and wound disruption.
Readmissions in plastic surgery can be largely attributed to new complications arising after discharge from the index hospitalization. The underlying reasons for readmission vary by procedure in a time-sensitive manner, and should be considered in future policy targeting readmission reduction.
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