The NSQIP 30-Day Challenge: Reliability of Outcomes Reporting in Microsurgical Breast Reconstruction
Austin D. Chen, Parisa Kamali, Anmol Chattha, Alexandra Bucknor, Justin B. Cohen, Patrick P. Bletsis, Renata Flecha-Hirsch, Adam M. Tobias, Bernard T. Lee, Samuel J. Lin
Beth Israel Deaconess Medical Center, Boston, MA, USA
Background: The aim is 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 (IFTBR) by direct comparisons to our 30-day and overall institutional data, and assessing those that occur after 30 days.
Methods: Data were retrieved for consecutive IFTBR 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 two datasets.
Results: For institutional vs. ACS-NQSIP outcomes, there were no significant differences in surgical site infection (SSI) (30-day: 3.6% vs. 4.1%, p=0.818; overall: 5.3% vs. 4.1%, p=0.198), wound disruption (WD) (30-day: 1.3% vs. 1.5%, p=0.526; overall: 2.3% vs. 1.5%, p=0.560), or unplanned readmission (URA) (30-day: 2.3% vs. 3.3%, p=0.714; overall: 4.6% vs. 3.3%, p=0.061). However, the ACS-NSQIP reported a significantly higher unplanned reoperation (URO) rate (30-day: 3.6% vs. 9.5%, p<0.001; overall: 5.3% vs. 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 surgical site infection, wound disruption, unplanned reoperation, and unplanned readmission 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.
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