187. Evaluation of Healthcare Resource Utilization After Autologous Microvascular Breast Reconstruction: A Retrospective 8 Year Single Center Experience

PURPOSE: Healthcare resource utilization (HCRU) is defined as the use of health services for preventing or treating health problems. Post-surgical HCRU in the form of emergency department (ED) utilization, re-admission, and re-operation within the global period significantly impacts reimbursement costs and practice specific outcomes. Multiple studies have analyzed patient and surgical factors associated with adverse surgical outcomes in autologous breast reconstruction (ABR). However, there is minimal data on HCRU after ABR. The purpose of this study is to evaluate the risk factors and etiologies of HCRU after ABR. METHODS: We performed retrospective review of all patients who underwent ABR with deep inferior epigastric artery perforator (DIEP) flap(s) at a large academic institution. Variables of interest included patient demographics, medical comorbidities, postoperative complications, presentation to the ED, re-admission to the hospital, and re-admission requiring re-operation. Major complications included urgent return to the operating room. Minor complications at the donor and recipient sites included infection, seroma, and various wound healing complications. Standard statistical analysis was performed with significance set to p < 0.05. RESULTS: Between 2015-2023, 591 patients underwent ABR with 984 DIEP flap(s). The mean age was 51 years and mean body mass index (BMI) was 29 kg/m2. 127 patients (22%) presented to the ED within 30 days of discharge, which was associated with a BMI > 30 kg/m2 (OR 1.6, p=0.013), hypercoagulable disorder (OR 2.6, p=0.023), depression (OR 2.3, p<0.001), any cardiac comorbidity (OR 1.7, p=0.012), any pulmonary comorbidity (OR 1.7, p=0.006), and urgent re-operation during index admission (OR 1.8, p=0.019). 89 patients (15%) were re-admitted within 30 days of discharge, which was associated with a BMI > 30 kg/m2 (OR 1.8, p=0.012), depression (OR 1.8, p=0.011), any cardiac comorbidity (OR 1.9, p=0.005), and urgent re-operation during index admission (OR 2.3, p=0.002) specifically for microvascular complications (OR 2.4, p=0.013). The most common reasons for re-admission included surgical site infection (n=40, 45%), medical complications predominantly deep vein thrombosis and/or pulmonary embolism (n=11, 12%) and delayed flap failure (n=9, 10%). Of the 89 patients re-admitted, 45 (51%) required operative intervention. The most common complications requiring readmission and re-operation included recipient surgical site infections (n=13, 29%), delayed flap failure (n=9, 20%), and recipient site hematomas (n=4, 9%). CONCLUSIONS: This is the first study of its kind to evaluate post-operative HCRU in patients undergoing ABR. BMI over 30 kg/m2, depression, cardiac and pulmonary comorbidities, and urgent re-operation during index admission significantly increase the risk of post-operative HCRU including ED presentation, hospital readmission, and need for re-operation. Plastic surgeons should utilize this information and optimize ABR patients in the peri-operative period to decrease adverse outcomes and HCRU.