National Trends in Autologous Breast Reconstruction with Free Tissue Transfer

Introduction

• Autologous breast reconstruction (ABR) offers durable outcomes and high patient satisfaction1,2

• National trends in ABR postoperative outcomes over time remain incompletely characterized

• This study analyzes a 12-year national cohort to evaluate temporal trends in ABR utilization, patient characteristics, and short-term outcomes

Methods

• Sample: 20,991 patients undergoing free flap ABR (2011-2022 NSQIP data)

• CPT Code: 19364 for free flap ABR

• Exclusions: Emergency cases

• Cohorts: Stratified into 3-year intervals (2011–2013, 2014–2016, 2017–2019, 2020–2022)

• Outcomes: 30-day all-cause complications, reoperation, readmission, and surgical site infection (SSI)

• Analysis: Compared cohorts utilizing multivariable logistic regression for adjusted odds ratios; marginal effects for predicted complication risk (p < 0.05 significant)

Results

Temporal Trends – Univariate

• Any complication: 25.1 → 23.2%

• SSI: 4.6% → 9.2%

• Operative time: 8.3 → 7.5 hours

• Length of stay: 4.7 → 3.4 days

• Reoperation: 12.1% → 10.7%

• Readmission: 6.5% → 5.2%

   ○ all p < 0.02

Multivariable Analysis (vs. 2011–2013)

• All-Cause Complications

   ○ 2014–2016: OR 0.90, p = 0.056

   ○ 2017–2019: OR 0.87, p = 0.009

   ○ 2020–2022: OR 0.99, p = 0.905

• Surgical Site Infection

   ○ 2014–2016: OR 0.87, p = 0.314

   ○ 2017–2019: OR 1.48, p = 0.001

   ○ 2020–2022: OR 2.21, p < 0.001

• Readmission

   ○ 2014–2016: OR 0.82, p = 0.050

   ○ 2017–2019: OR 0.98, p = 0.866

   ○ 2020–2022: OR 0.86, p = 0.107

• Reoperation

   ○ 2014–2016: OR 1.03, p = 0.651

   ○ 2017–2019: OR 0.98, p = 0.743

   ○ 2020–2022: OR 0.95, p = 0.448

Conclusion

• ABR has become more utilized and efficient, with declining operative times and shorter hospital stays

• Complication and reoperation rates improved from 2011 to 2019 but showed no further gains in the most recent cohort

• SSI significantly increased, highlighting a need for strengthened infection control and perioperative management

• Ongoing surveillance of national trends in ABR can guide development of standardized protocols and identify emerging quality concerns