Northeastern Society of Plastic Surgeons

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The Outpatient Expansion: Assessing the 26% Increase in Outpatient Alloplastic Breast Reconstructions and Its Implications for Safety and Racial Equity
Nancy Qin*1, Izzet Akosman1, Benjamin Wesorick1, David Dugue2, Makayla Kochheiser1, Anna M. Vaeth1, David Otterburn2
1Weill Cornell Medical College, New York, NY; 2Division of Plastic and Reconstructive Surgery, NewYork Presbyterian-Cornell Columbia, New York, NY

Introduction: The prevalence of outpatient (OP) procedures across all surgical disciplines has markedly increased since the onset of COVID-19. This study aims to use the National Surgical Quality Improvement Program (NSQIP) database to quantify the extent of the transition from inpatient (IP) to OP for breast mastectomy with immediate alloplastic reconstruction. Additionally, we will assess the safety profile and potential impact of racial disparities on postoperative outcomes in both settings.
Methods: Patients undergoing mastectomy with immediate tissue expander or implant reconstruction from 2018 to 2022 were identified using Current Procedural Terminology (CPT) codes. Rates of OP and IP mastectomy and reconstruction procedures were compared between pre-COVID (2018-2019) and post-COVID (2021-2022). 19,904 patients who underwent surgery between 2020-2022 were divided into OP and IP groups, and further stratified by racial groups. Propensity score matching based on various comorbidities was conducted prior to comparing postoperative outcomes.
Results: Analysis of the NSQIP data showed a 26% rise in the proportion of OP breast alloplastic reconstructions, increasing from 8% in the pre-COVID period to 34% in the post-COVID period. Within our matched dataset, IP patients were more likely to require postoperative transfusions (0.7% vs. 0.08%) and undergo readmission (4.4% vs 3.0%) and re-operation (7.9% vs 5.6%) compared to OP patients (p<0.0001). However, OP patients were significantly more likely to develop wound dehiscence (1.2% vs 0.8%, p=0.03). Among the matched IP cohort, black patients were significantly more likely to develop wound dehiscence (1.0% vs 0.5%) and require postoperative transfusions (1.7% vs 0.6%). However, rates of postoperative complications were comparable between black and white patients in the matched OP cohort.
Conclusion: Despite the drastic increase in outpatient alloplastic breast reconstructions since the pandemic, our data suggest that this transition is relatively safe.

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