Characterizing Risk Factors for 30-Day Readmission in Autologous Breast Reconstruction Patients with DIEP Flaps

Advances in microsurgery and the adoption of ERAS (enhanced recovery after surgery) protocols have improved patient care in free flap breast reconstruction. However, there are limited and variable data on hospital readmissions after these procedures. This study aimed to identify prognostic factors associated with hospital readmission in patients undergoing autologous breast reconstruction with deep inferior epigastric perforator (DIEP) flaps.

A retrospective chart review was conducted on patients undergoing DIEP flap breast reconstruction at an academic center between 2015 and 2023. Patients readmitted within 30 days of discharge were identified. Univariable and multivariable regression analyses were used to determine risk factors for hospital readmission. The least absolute shrinkage and selection operator method was applied for feature selection in the multivariable analysis. Statistical significance was set at P ≤ 0.05.

A total of 592 patients were reviewed. A readmission rate of 15.9% was observed, which is higher than the literature-reported range of 4.7% to 5.8%. Multivariable regression analysis identified a body mass index of 30 kg/m 2 or greater ( P = 0.033) and the presence of a coagulability disorder ( P = 0.042) as independent risk factors for hospital readmission. Surgical site infections were the primary reason for readmission, affecting 45.7% of readmitted patients (43 of 94).

Factors such as a body mass index of 30 kg/m 2 or greater and the presence of a coagulability disorder should be carefully considered to reduce readmission rates after DIEP flap breast reconstruction. Patients with these factors may benefit from increased preoperative planning, including the development of protocols that target these factors and strategies aimed at reducing infection and readmission rates.