The Influence of Hospital Teaching Status on Patient 90-Day Readmission Following Autologous Breast Reconstruction: A Nationwide Readmissions Database Analysis
Uchechukwu O. Amakiri1, Taylor J. Ibelli BS1; Whitney Moss2, Giovanna Pires2, Devin Eddington3, Jocelyn Lu1, Peter J. Taub1, Alvin C. Kwok2
1Department of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York; 2Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA; 3Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
Background: Hospital characteristics have been shown to impact patient surgical outcomes. One such factor is a hospital’s teaching status, and currently, there is a discrepancy in the literature regarding the impact of hospital teaching status on patient outcomes following surgery, varying by surgical specialty, procedure, and complexity of the operation. The purpose of this study was to examine the influence of hospital teaching hospital status on patient outcomes, specifically 90-day readmission, following autologous breast reconstruction (ABR), identifying a possible risk factor for poor patient outcomes after a complex surgery.
Methods: A retrospective review of the Nationwide Readmission Database (NRD) between 2015 and 2018 was conducted. ICD-10 codes were used to identify patients aged ≥ 18 years with a diagnosis of breast cancer who underwent elective ABR. Patients were stratified by the teaching status of the hospital in which they received their ABR, and the demographic characteristics of the cohorts were compared. Hospital characteristics were also compared, stratified by hospital teaching status, and descriptive analysis was performed. Statistical analysis was performed to assess the association of different factors on 90-day readmission following ABR.
Results: A total of 13,524 patients were eligible for the study. The majority of ABR was performed in teaching hospitals, accounting for 89.8% of ABR surgeries between 2015 and 2018. Status as a teaching hospital was associated with fewer 90-day readmission (p = 0.037). There was also an association between 90-day readmission and patient disposition (p = 0.010), payer status (p < 0.001), patient income (p < 0.001), hospital teaching status (p = 0.009), hospital rural-urban designation (p = 0.042), and hospital ownership (p = 0.009). There was no association between patient age and 90-day readmission.
Conclusion: Teaching hospitals are associated with fewer 90-day readmissions following ABR. This study identifies hospital teaching status as a significant factor influencing patient outcomes. Future studies should examine equity issues regarding the type of patients who utilize these different institutions in order to relate this to patient outcomes.
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