39 The Influence of Reconstruction Type on Outcomes in Women Undergoing Mastectomy With Immediate Reconstruction: A Nationwide Study

Background

The study aimed to compare the most common reconstruction techniques used in mastectomy with immediate reconstruction in a large national cohort of women, due to limited and inconsistent evidence on the outcomes associated with different reconstruction types.

Methods

The study analyzed the Nationwide Readmissions Database from 2016 to 2020 to examine women over 18 undergoing mastectomies with immediate reconstruction. The outcomes assessed were prolonged length of stay (LOS; 7 days or more), readmission within 30 days, and readmission to a different hospital. Reconstruction types and relevant variables were compared using chi-squared tests and multivariable logistic regression, controlling for significant confounders.

Results

During the study period, 35,430 patients were identified as undergoing mastectomy for breast cancer with immediate reconstruction. The rate of prolonged LOS was 2.4% (n = 840) and the readmission rate was 5.4% (n = 1919). From the readmitted patients, the rate of readmission to a different hospital was 14.2% (n=273). Controlling for confounders with multivariable logistic regression revealed the strongest risk factors for prolonged LOS were latissimus dorsi flap (OR, 5.4; 95% CI, 4.0-7.4; P <.001) and an investor-owned hospital (OR, 4.3; 95% CI, 3.5-5.2; P <.001). The highest risk of readmission was a transverse rectus abdominis flap (OR, 1.3; 95% CI, 1.1-1.6; P <.001), and the highest risk of readmission to a different hospital was a small hospital (OR, 2.2; 95% CI, 1.6-3.1; P <.001).

Conclusions

Reconstruction type impacts mastectomy outcomes, with implications for surgical decision-making and care fragmentation. More research is needed to improve patient satisfaction and reduce adverse outcomes.