{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T22:14:27Z","timestamp":1787004867096,"version":"build-2736575974"},"reference-count":30,"publisher":"Georg Thieme Verlag KG","issue":"07","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>To assess the burden of postdischarge health care utilization given by readmissions beyond 30 days following immediate breast reconstruction (IBR) nationwide.<\/jats:p>\n                  <jats:p>Women with breast cancer who underwent mastectomy and concurrent IBR (autologous and implant-based) were identified within the 2010 to 2019 Nationwide Readmission Database. Cox proportional hazards and generalized linear regression controlling for patient- and hospital-level confounders were used to determine factors associated with 180-day unplanned readmissions and incremental hospital costs, respectively.<\/jats:p>\n                  <jats:p>Within 180 days, 10.7% of 100,942 women were readmitted following IBR. Readmissions tended to be publicly insured (30.8 vs. 21.7%, p\u2009&lt;\u20090.001) and multimorbid (Elixhauser Comorbidity Index\u2009&gt;\u20092 31.6 vs. 19.6%, p\u2009&lt;\u20090.001) compared with nonreadmitted patients. There were no differences in readmission rates among types of IBR (tissue expander 11.2%, implant 10.7%, autologous 10.8%; p\u2009&gt;\u20090.69). Of all readmissions, 40% occurred within 30 days and 21.7% in a different hospital and 40% required a major procedure in the operating room. Infection was the leading cause of readmissions (29.8%). In risk-adjusted analyses, patients with carcinoma in situ, publicly insured, low socioeconomic status, and higher comorbidity burden were associated with increased readmissions (all p\u2009&lt;\u20090.05). Readmissions resulted in additional $8,971.78 (95% confidence interval: $8,537.72\u20139,405.84, p\u2009&lt;\u20090.001) in hospital costs, which accounted for 15% of the total cost of IBR nationwide.<\/jats:p>\n                  <jats:p>The majority of inpatient health care utilization given by readmissions following mastectomy and IBR occurs beyond the 30-day benchmark. There is evidence of fragmentation of care as a quarter of readmissions occur in a different hospital and over one-third require major procedures. Mitigating postoperative infectious complications could result in the highest reduction of readmissions.<\/jats:p>","DOI":"10.1055\/a-2460-4821","type":"journal-article","created":{"date-parts":[[2024,11,4]],"date-time":"2024-11-04T20:16:47Z","timestamp":1730751407000},"page":"575-585","source":"Crossref","is-referenced-by-count":4,"title":["Unplanned 180-day Readmissions and Health Care Utilization after Immediate Breast Reconstruction for Breast Cancer"],"prefix":"10.1055","volume":"41","author":[{"given":"Arturo J.","family":"Rios-Diaz","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodore E.","family":"Habarth-Morales","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania"},{"name":"Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily L.","family":"Isch","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Amro","sequence":"additional","affiliation":[{"name":"Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harrison D.","family":"Davis","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania"},{"name":"Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robyn B.","family":"Broach","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Jenkins","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John P.","family":"Fischer","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph M.","family":"Serletti","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2024,12,23]]},"reference":[{"issue":"04","key":"ref1","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1001\/jama.2013.42","article-title":"Revisiting hospital readmissions","volume":"309","author":"P B Fontanarosa","year":"2013","journal-title":"JAMA"},{"issue":"03","key":"ref2","doi-asserted-by":"crossref","first-page":"320e","DOI":"10.1097\/PRS.0b013e31827cf576","article-title":"A paradigm shift in U.S. breast reconstruction: part 2. The influence of changing mastectomy patterns on reconstructive rate and method","volume":"131","author":"Y Cemal","year":"2013","journal-title":"Plast Reconstr Surg"},{"issue":"13","key":"ref3","doi-asserted-by":"crossref","first-page":"2462","DOI":"10.1002\/cncr.28050","article-title":"Trends in immediate breast reconstruction across insurance groups after enactment of breast cancer legislation","volume":"119","author":"R L Yang","year":"2013","journal-title":"Cancer"},{"issue":"02","key":"ref4","doi-asserted-by":"crossref","first-page":"284e","DOI":"10.1097\/PRS.0000000000006478","article-title":"Evidence-based performance measures for autologous breast reconstruction: An American Society of Plastic Surgeons quality Performance Measure Set","volume":"145","author":"A Siddiqui","year":"2020","journal-title":"Plast Reconstr Surg"},{"issue":"06","key":"ref5","doi-asserted-by":"crossref","first-page":"775e","DOI":"10.1097\/PRS.0000000000003845","article-title":"Evidence-based performance measures: quality metrics for the care of patients undergoing breast reconstruction","volume":"140","author":"M A Manahan","year":"2017","journal-title":"Plast Reconstr Surg"},{"issue":"04","key":"ref6","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1097\/SAP.0b013e3182a0df25","article-title":"Predictors of readmission after breast reconstruction: a multi-institutional analysis of 5012 patients","volume":"71","author":"A S Mlodinow","year":"2013","journal-title":"Ann Plast Surg"},{"issue":"03","key":"ref7","doi-asserted-by":"crossref","first-page":"360e","DOI":"10.1097\/PRS.0000000000005903","article-title":"Are 30-day outcomes enough? Late infectious readmissions following prosthetic-based breast reconstruction","volume":"144","author":"W Collier","year":"2019","journal-title":"Plast Reconstr Surg"},{"issue":"02","key":"ref8","doi-asserted-by":"crossref","first-page":"e4112","DOI":"10.1097\/GOX.0000000000004112","article-title":"Autologous breast reconstruction is associated with lower 90-day readmission rates","volume":"10","author":"J D Sawyer","year":"2022","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"05","key":"ref9","doi-asserted-by":"crossref","first-page":"928","DOI":"10.1097\/PRS.0b013e3182865977","article-title":"Breast reconstruction modality outcome study: a comparison of expander\/implants and free flaps in select patients","volume":"131","author":"J P Fischer","year":"2013","journal-title":"Plast Reconstr Surg"},{"issue":"S 03","key":"ref10","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1245\/s10434-010-1261-3","article-title":"Complication rates of radiation on tissue expander and autologous tissue breast reconstruction","volume":"17","author":"T Berry","year":"2010","journal-title":"Ann Surg Oncol"},{"issue":"04","key":"ref11","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1097\/PRS.0000000000002530","article-title":"Antibiotic prophylaxis following implant-based breast reconstruction: what is the evidence?","volume":"138","author":"B T Phillips","year":"2016","journal-title":"Plast Reconstr Surg"},{"issue":"02","key":"ref12","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1007\/s40506-017-0117-9","article-title":"Surveillance and prevention of surgical site infections in breast oncologic surgery with immediate reconstruction","volume":"9","author":"M A Olsen","year":"2017","journal-title":"Curr Treat Options Infect Dis"},{"issue":"09","key":"ref13","doi-asserted-by":"crossref","first-page":"e2231583","DOI":"10.1001\/jamanetworkopen.2022.31583","article-title":"Effectiveness of single vs multiple doses of prophylactic intravenous antibiotics in implant-based breast reconstruction: a randomized clinical trial","volume":"5","author":"J Gahm","year":"2022","journal-title":"JAMA Netw Open"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"S481","DOI":"10.1097\/SAP.0000000000003124","article-title":"Impact of socioeconomic status on breast reconstruction outcomes","volume":"88","author":"M S Martin","year":"2022","journal-title":"Ann Plast Surg"},{"issue":"04","key":"ref15","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1111\/tbj.12274","article-title":"Socioeconomic and geographic differences in immediate reconstruction after mastectomy in the United States","volume":"20","author":"B Wexelman","year":"2014","journal-title":"Breast J"},{"issue":"03","key":"ref16","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1007\/s10549-022-06697-y","article-title":"Barriers to breast reconstruction for socioeconomically disadvantaged women","volume":"195","author":"T J Stankowski","year":"2022","journal-title":"Breast Cancer Res Treat"},{"issue":"11","key":"ref17","doi-asserted-by":"crossref","first-page":"6099","DOI":"10.1245\/s10434-021-10487-z","article-title":"Persistent disparities in postmastectomy breast reconstruction and strategies for mitigation","volume":"28","author":"P D Butler","year":"2021","journal-title":"Ann Surg Oncol"},{"issue":"05","key":"ref18","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1016\/j.amjsurg.2019.06.017","article-title":"Unplanned readmissions following breast cancer surgery","volume":"218","author":"T A James","year":"2019","journal-title":"Am J Surg"},{"issue":"02","key":"ref19","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1097\/PRS.0000000000002344","article-title":"Race and breast cancer reconstruction: is there a health care disparity?","volume":"138","author":"K Sharma","year":"2016","journal-title":"Plast Reconstr Surg"},{"key":"ref20","first-page":"S42","article-title":"Evaluation of racial disparities in postoperative outcomes following breast reconstruction at a single institution in Wisconsin","volume":"120","author":"Z H Nkana","year":"2021","journal-title":"WMJ"},{"issue":"04","key":"ref21","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1016\/j.amjsurg.2014.11.002","article-title":"African-American women have equivalent outcomes following autologous free flap breast reconstruction despite greater preoperative risk factors","volume":"209","author":"P D Butler","year":"2015","journal-title":"Am J Surg"},{"issue":"02","key":"ref22","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1111\/1475-6773.12712","article-title":"Log odds and the interpretation of logit models","volume":"53","author":"E C Norton","year":"2018","journal-title":"Health Serv Res"},{"issue":"04","key":"ref23","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1097\/SLA.0000000000001457","article-title":"A Longitudinal assessment of outcomes and healthcare resource utilization after immediate breast reconstruction-comparing implant- and autologous-based breast reconstruction","volume":"262","author":"J P Fischer","year":"2015","journal-title":"Ann Surg"},{"issue":"12","key":"ref24","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1001\/jamasurg.2018.2488","article-title":"Three common methodological issues in studies of surgical readmission rates: the trouble with readmissions","volume":"153","author":"C K Zogg","year":"2018","journal-title":"JAMA Surg"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"S114","DOI":"10.1093\/neuros\/nyw066","article-title":"Prevention of surgical site infection in spine surgery","volume":"80","author":"P A Anderson","year":"2017","journal-title":"Neurosurgery"},{"issue":"05","key":"ref26","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1016\/j.ctrv.2011.12.011","article-title":"The ethnic divide in breast reconstruction: a review of the current literature and directions for future 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between hospital volume and outcome for autologous breast reconstruction","volume":"132","author":"C R Albornoz","year":"2013","journal-title":"Plast Reconstr Surg"},{"issue":"S 01","key":"ref30","doi-asserted-by":"crossref","first-page":"S27","DOI":"10.1016\/j.ejso.2010.06.024","article-title":"A systematic review and meta-analysis of the volume-outcome relationship in the surgical treatment of breast cancer. Are breast cancer patients better of with a high volume provider?","volume":"36","author":"G A Gooiker","year":"2010","journal-title":"Eur J Surg Oncol"}],"container-title":["Journal of Reconstructive Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2460-4821.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,8]],"date-time":"2025-08-08T22:49:40Z","timestamp":1754693380000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2460-4821"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,4]]},"references-count":30,"journal-issue":{"issue":"07","published-online":{"date-parts":[[2025,8,8]]},"published-print":{"date-parts":[[2025,9]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2460-4821","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0743-684X","1098-8947"],"issn-type":[{"value":"0743-684X","type":"print"},{"value":"1098-8947","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,11,4]]},"published":{"date-parts":[[2024,11,4]]}}}