Development of a preliminary exploratory index to predict safety of same-day discharge following immediate...

Immediate alloplastic breast reconstruction often requires inpatient admission to monitor for postoperative complications. Outpatient procedures typically result in lower costs and fewer nosocomial infections. We sought to develop an index score predicting 48-h postoperative complications after immediate alloplastic reconstruction to determine the feasibility of same-day discharge.

We retrospectively reviewed patients who underwent immediate alloplastic reconstruction from July 2016 to January 2022 within our health system. We abstracted demographics, surgical details, and 48-h postoperative complications. Bivariate analyses examined the associations between complications and patient/surgery characteristics. We evaluated factors that applied to 10-60% of the sample with odds ratio >1 to develop an index score. Significance was set at p<0.05.

We included 1297 patients. Median age was 51 years; median BMI was 24.9 kg/m². Twenty-three patients (1.77%) experienced 24 complications (hematoma, skin necrosis, medical complication, and seroma) within 48 h. We identified nine factors for our index: (1) Black race, (2) former smoking history, (3) history of anxiety, (4) ASA Class III, (5) unilateral surgery, (6) total/simple mastectomy, (7) no axillary procedures, (8) implant-based reconstruction, and (9) procedure duration ≥256 min. This index had statistically different distributions between patients who did and did not develop complications (p<0.001) and having ≥3 factors corresponded to high risk. Applying our index, 69.6% of patients were recommended for outpatient reconstruction with expected complication rate of 0.7%.

We found a low 48-h postoperative complication rate (1.77%) for immediate alloplastic breast reconstruction. Our preliminary exploratory index recommended that over two-thirds of patients undergo outpatient reconstruction with a predicted 48-h complication rate <1%. Larger confirmatory studies are warranted.