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Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
The National Surgical Quality Improvement Program 30-Day Challenge: Microsurgical Breast Reconstruction Outcomes
Austin D Chen1, Parisa Kamali1, Anmol S Chattha1
1Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.; and Department of Plastic, Reconstructive and Hand Surgery, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands.
Background:
The aim was to assess reliability of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) 30-day perioperative outcomes and complications for immediate, free-tissue transfer breast reconstruction by direct comparisons with our 30-day and overall institutional data, and assessing those that occur after 30 days.
Methods:
Data were retrieved for consecutive immediate, free-tissue transfer breast reconstruction patients from a single-institution database (2010-2015) and the ACS-NSQIP (2011-2014). Multiple logistic regressions were performed to compare adjusted outcomes between the 2 datasets.
Results:
For institutional versus ACS-NSQIP outcomes, there were no significant differences in surgical-site infection (SSI; 30-day, 3.6% versus 4.1%, P = 0.818; overall, 5.3% versus 4.1%, P = 0.198), wound disruption (WD; 30-day, 1.3% versus 1.5%, P = 0.526; overall, 2.3% versus 1.5%, P = 0.560), or unplanned readmission (URA; 30-day, 2.3% versus 3.3%, P = 0.714; overall, 4.6% versus 3.3%, P = 0.061). However, the ACS-NSQIP reported a significantly higher unplanned reoperation (URO) rate (30-day, 3.6% versus 9.5%, P < 0.001; overall, 5.3% versus 9.5%, P = 0.025). Institutional complications consisted of 5.3% SSI, 2.3% WD, 5.3% URO, and 4.6% URA, of which 25.0% SSI, 28.6% WD, 12.5% URO, and 7.1% URA occurred at 30-60 days, and 6.3% SSI, 14.3% WD, 18.8% URO, and 42.9% URA occurred after 60 days.
Conclusion:
For immediate, free-tissue breast reconstruction, the ACS-NSQIP may be reliable for monitoring and comparing SSI, WD, URO, and URA rates. However, clinicians may find it useful to understand limitations of the ACS-NSQIP for complications and risk factors, as it may underreport complications occurring beyond 30 days.
Insights
The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) accurately tracks 30-day outcomes for breast reconstruction. However, it may underreport complications occurring after 30 days.
Area of Science:
- Plastic Surgery
- Surgical Quality Improvement
- Breast Reconstruction Outcomes
Background:
- Assessing the reliability of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) for 30-day perioperative outcomes in immediate, free-tissue transfer breast reconstruction.
- Comparing ACS-NSQIP data with institutional data, including complications occurring beyond 30 days.
Purpose of the Study:
- To evaluate the accuracy of ACS-NSQIP in reporting surgical-site infection (SSI), wound disruption (WD), unplanned readmission (URA), and unplanned reoperation (URO) rates.
- To identify potential underreporting of complications by ACS-NSQIP, particularly those occurring after the 30-day window.
Main Methods:
- Retrieved data from a single institution (2010-2015) and ACS-NSQIP (2011-2014) for immediate, free-tissue transfer breast reconstruction patients.
- Utilized multiple logistic regressions to compare adjusted outcomes between the institutional and ACS-NSQIP datasets.
Main Results:
- No significant differences were found between institutional and ACS-NSQIP for 30-day and overall SSI, WD, and URA rates.
- ACS-NSQIP reported a significantly higher rate of unplanned reoperations (URO) compared to institutional data (30-day: 9.5% vs 3.6%; overall: 9.5% vs 5.3%).
- A notable percentage of institutional complications (SSI, WD, URO, URA) occurred between 30 and 60 days, and after 60 days, suggesting potential underreporting by ACS-NSQIP.
Conclusions:
- ACS-NSQIP demonstrates reliability for monitoring and comparing 30-day outcomes (SSI, WD, URO, URA) in immediate, free-tissue breast reconstruction.
- Clinicians should be aware of ACS-NSQIP's limitations in capturing complications that manifest beyond 30 days.
- Understanding these limitations is crucial for comprehensive complication assessment and risk factor analysis in breast reconstruction surgery.
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