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Unplanned 30-day readmission rates after plastic and reconstructive surgery procedures: a systematic review and meta-analysis

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Abstract

Background

Identifying risk factors for unplanned hospital readmission is beneficial in terms of costs and utilization of resources. This systematic review aimed to identify and compare the rates and common reasons for readmission following reconstructive and esthetic surgery.

Methods

Adhering to PRISMA guidelines, we searched PubMed, Web of Science, and CENTRAL database. No publication date or language restrictions were applied. Outcomes included 30-day readmission rate, reasons for readmission, and complications after reconstructive or esthetic surgery. Weighted individual study estimates were used to calculate pooled 30-day readmission rates using a random-effects approach. Risk ratios (RRs) or odds ratios (ORs) and 95% confidence intervals (CIs) were used to describe pooled estimates for risk factors.

Results

A total of 29 studies were included in the meta-analysis. Overall readmission rates were 10.3% (95%CI 6.3–14.3) after head and neck reconstruction, 4.6% (95%CI 3.7–5.5) after breast reconstruction, 2.4% (95%CI 1.57–3.17) after other breast surgeries, 3.0% (95%CI 0.2–5.8) after esthetic surgery, and 14.1% (95%CI 2.0–26.2) after free tissue transfer of any type. Statistically significant risk factors after head and neck reconstructions included pre-existing diabetes (RR 1.20; 95%CI 1.09–1.33), congestive heart failure (RR 1.67; 95%CI 1.43–1.94), prior radiation (OR1.17; 95%CI 1.06–1.30), and perioperative blood transfusion (OR 1.44; 95%CI:1.22–1.70).

Conclusions

There is a large difference for readmission rates depending on the complexity of the procedure. Few studies report unplanned readmission rates in esthetic surgery and general free tissue transfer. Whereas readmissions after head and neck reconstruction are well-evaluated, risk factors for other reconstructive surgeries are poorly reported. Closer follow-up visits and outpatient resources could decrease readmission rates.

Level of Evidence: Not ratable.

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Acknowledgments

We would like to thank Janet S. Burk from the Moody Medical Library at the University of Texas Medical Branch at Galveston for her assistance in performing the literature search.

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Authors and Affiliations

  1. Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children-Galveston®, 815 Market Street, Galveston, TX, 77550, USA

    Christian Tapking, Alexis L. Boson, Victoria G. Rontoyanni, Daniel Popp & Ludwik K. Branski

  2. Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany

    Christian Tapking, Gabriel Hundeshagen & Valentin F. M. Haug

  3. School of Medicine, University of Texas Medical Branch, Galveston, TX, USA

    Alexis L. Boson

  4. Metabolism Unit, Shriners Hospitals for Children, Galveston, TX, USA

    Victoria G. Rontoyanni

  5. Department of Urology, University Medical Center Mannheim, University of Heidelberg, Heidelberg, Germany

    Karl F. Kowalewski

  6. Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Valentin F. M. Haug

  7. Department of Dermatology and Allergology, University Hospital of RWTH Aachen, Aachen, Germany

    Khosrow S. Houschyar

  8. Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria

    Daniel Popp & Ludwik K. Branski

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  1. Christian Tapking
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Contributions

Study conception and design: CT, ALB, VGR, GH, LKB; acquisition of the data: CT, ALB, VGR; statistical analysis: CT, ALB, VGR; analysis and interpretation of the data: CT, VGR, KFK, VH, DP, KSH, LKB; drafting of the manuscript: CT, ALB, VGR, KFK, GH, DP; critical revision: KFK, GH, VH, KSH, LKB. All the authors approved the final version of the manuscript.

Corresponding author

Correspondence to Ludwik K. Branski.

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Conflict of interest

The authors C. Tapking, A.L. Boson, V.G. Rontoyanni, K.F. Kowalewski, G. Hundeshagen, V. Haug, K.S. Houschyar, D. Popp and L.K. Branski declare that they have no conflict of interest.

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This is a systematic review. The local institutional review board has confirmed that no ethical approval is required.

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This is a systematic review. Informed consent is not required.

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Systematic review registration: PROSPERO: CRD42019117650

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Appendix

Appendix

Search strategy for PubMed

(((((((((aesthetic surgery OR aesthetic surgeries))) OR (“Free Tissue Flaps”[Mesh] OR “free flap” OR “free tissue flap” OR “microsurgical free flap” OR “free tissue transfer”)) OR (“Surgical Flaps”[Mesh] OR pedicle* flap* OR island flap* OR surgical flap*)) OR (“Reconstructive Surgical Procedures”[Mesh] OR “cosmetic reconstructive” OR “reconstructive surgical” OR “reconstructive surgery” OR “reconstructive surgery”)) OR (“cosmetic surgery” OR “cosmetic surgeries” OR “esthetic surgeries” OR “esthetic surgery” OR “plastic surgery” OR “plastic surgeries”))) AND (((“Patient Readmission”[Mesh] OR rehospitalize OR rehospitalized OR rehospitalization OR re-hospitaliz* OR re-hospitalis* OR rehospitalis*)) OR readmission)

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Tapking, C., Boson, A.L., Rontoyanni, V.G. et al. Unplanned 30-day readmission rates after plastic and reconstructive surgery procedures: a systematic review and meta-analysis. Eur J Plast Surg 43, 701–712 (2020). https://doi.org/10.1007/s00238-020-01731-y

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  • DOI: https://doi.org/10.1007/s00238-020-01731-y

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