Predictors of 30-day readmission after mastectomy: A multi-institutional analysis of 21,271 patients.

BACKGROUND: Recent healthcare legislation has made unplanned hospital readmission an important metric of health care quality, and current efforts center on reducing this complication in order to avoid fiduciary penalties. OBJECTIVE: There is currently a paucity of data delineating risk factors for readmission following mastectomy. To this end, we sought to develop a predictive model of unplanned readmissions following mastectomy. METHODS: The 2011 and 2012 National Surgical Quality Improvement Program (NSQIP) datasets were retrospectively queried to identify patients who underwent mastectomy. Multivariate logistic regression modeling was used to identify risk factors for readmission. RESULTS: Of 21,271 patients meeting inclusion criteria, 1,190 (5.59%) were readmitted. The most commonly cited reasons for readmission included surgical site complications (32.85%), infection not localized to the surgical site (2.72%), and venous thromboembolism (4.39%). Independent predictors of readmission included BMI, active smoking status, and skin-sparing mastectomy. Significantly, concurrent breast reconstruction and bilateral mastectomy were not independent predictors of readmission. CONCLUSIONS: This is the first study of readmission rates after mastectomy. Awareness of specific risk factors for readmission, particularly those that are modifiable, may serve to identify and manage high risk patients, aid in the development of pre- and postoperative clinical care guidelines, and ultimately improve patient care.

Impact of neonatal NOS-1 inhibitor exposure on neurobehavioural measures and prefrontal-temporolimbic integration in the rat nucleus accumbens.

Nitric oxide (NO) is a gaseous neurotransmitter that plays a significant role in the establishment and refinement of functional neural circuits. Genetic and post-mortem studies have suggested that neuronal NO synthase (NOS-1) activity may be compromised in frontal and temporal lobes, and related structures, in schizophrenia. The goal of this study was to determine if there is a link between neonatal disruptions in NO signalling and disturbances in the development and function of prefrontal-temporolimbic circuits. Neonatal rats were injected on postnatal days PD3-5 with the selective NOS-1 inhibitor Nω-propyl-L-arginine (NPA) and tested in adulthood (≥PD60) or as juveniles (PD30). Adult rats treated with NPA as neonates exhibited increased amphetamine-induced locomotion compared to animals receiving vehicle as neonates, whereas this was not observed in juvenile rats treated with NPA as neonates. Adult rats exposed to NPA as neonates also exhibited deficits in social interaction and short-term recognition memory, as well as reduced brain weight, compared to vehicle-treated controls. Finally, neonatal NPA exposure increased the responsiveness of nucleus accumbens neurons to prefrontal cortical input and disrupted the modulation of cortico-accumbens circuits by hippocampal afferents that is normally observed in adult animals. These results show for the first time that neonatal inhibition of NOS-1 during a critical neurodevelopmental period leads to aberrant behaviours that manifest in adulthood, as well as electrophysiological abnormalities in prefrontal-temporolimbic circuits. Greater understanding of the role of NOS-1 in the development of these circuits will shed light on how developmental insults translate to pathophysiology associated with schizophrenia.