Lack of Validity of the American College of Surgeons National Surgical Quality Improvement Program Database for Alloplastic Immediate Postmastectomy Reconstruction.

Background: The American College of Surgeons National Surgical Quality Improvement Program is an outcomes-based program with the objective of improving quality of surgical care. With its size and validity, the database has been mined by both general and plastic surgery clinical researchers to provide information for possible risk reduction strategies and patient counseling. However, the 30-day window of the program's database may be inappropriately brief in documentation of complications for some operative procedures. The authors' hypothesis was that the database underestimated complications in alloplastic reconstruction, particularly prosthesis loss.

Methods: A cohort of 346 patients and 511 immediate postmastectomy reconstructions was analyzed for reconstruction failure. The inclusion criterion was patients who underwent reconstruction with tissue expanders followed by removal because of complications of infection and/or exposure. The hiatus between surgery (postmastectomy reconstruction) and loss of the tissue expander was recorded. Demographic data and risk factors and postoperative complications of mastectomy skin necrosis and seroma were tabulated.

Results: Fifty-five tissue expanders were explanted in the postoperative period secondary to infection and/or exposure. Of the total, 19 tissue expanders were explanted within 30 days, 36 after the 30-day window (mean, 62 days; median, 43 days). Approximately 65 percent of the tissue expanders destined for eventual loss were still in situ at 30 days. No significant difference existed between the two groups, early and late, regarding risk factors or postoperative mastectomy skin necrosis and seroma.

Conclusion: The American College of Surgeons National Surgical Quality Improvement Program database significantly underestimates the risk of tissue expander loss because of the 30-day limitation in data accrual.

Clinical Question/level Of Evidence: Therapeutic, III.