Unplanned 30-day readmission rates after plastic and reconstructive surgery procedures: a systematic review and meta-analysis

Background Identifying risk factors for unplanned hospital readmission is beneficial in terms of costs and utilization of resources. This systematic review aimed to identify and compare the rates and common reasons for readmission following reconstructive and esthetic surgery. Methods Adhering to PRISMA guidelines, we searched PubMed, Web of Science, and CENTRAL database. No publication date or language restrictions were applied. Outcomes included 30-day readmission rate, reasons for readmission, and complications after reconstructive or esthetic surgery. Weighted individual study estimates were used to calculate pooled 30-day readmission rates using a random-effects approach. Risk ratios (RRs) or odds ratios (ORs) and 95% confidence intervals (CIs) were used to describe pooled estimates for risk factors. Results A total of 29 studies were included in the meta-analysis. Overall readmission rates were 10.3% (95%CI 6.3-14.3) after head and neck reconstruction, 4.6% (95%CI 3.7-5.5) after breast reconstruction, 2.4% (95%CI 1.57-3.17) after other breast surgeries, 3.0% (95%CI 0.2-5.8) after esthetic surgery, and 14.1% (95%CI 2.0-26.2) after free tissue transfer of any type. Statistically significant risk factors after head and neck reconstructions included pre-existing diabetes (RR 1.20; 95%CI 1.09-1.33), congestive heart failure (RR 1.67; 95%CI 1.43-1.94), prior radiation (OR1.17; 95%CI 1.06-1.30), and perioperative blood transfusion (OR 1.44; 95%CI:1.22-1.70). Conclusions There is a large difference for readmission rates depending on the complexity of the procedure. Few studies report unplanned readmission rates in esthetic surgery and general free tissue transfer. Whereas readmissions after head and neck reconstruction are well-evaluated, risk factors for other reconstructive surgeries are poorly reported. Closer follow-up visits and outpatient resources could decrease readmission rates. Level of Evidence: Not ratable.