• Eric Winter, Gregory Glauser, Ian F Caplan, Stephen Goodrich, Scott D McClintock, Stephen J Kovach, Joshua Fosnot, Joseph M Serletti, and Neil R Malhotra.
• From the Department of Neurosurgery, and the Division of Plastic Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania; the McKenna EpiLog Fellowship in Population Health at the University of Pennsylvania; and the West Chester Statistical Institute and Department of Mathematics, West Chester University.
• Plast. Reconstr. Surg. 2020 Sep 1; 146 (3): 296e-305e.

BackgroundThis study used coarsened exact matching to investigate the effectiveness of the LACE+ index (i.e., length of stay, acuity of admission, Charlson Comorbidity Index, and emergency department visits in the past 6 months) predictive tool in patients undergoing plastic surgery.MethodsCoarsened exact matching was used to assess the predictive ability of the LACE+ index among plastic surgery patients over a 2-year period (2016 to 2018) at one health system (n = 5744). Subjects were matched on factors not included in the LACE+ index such as duration of surgery, body mass index, and race, among others. Outcomes studied included emergency room visits, hospital readmission, and unplanned return to the operating room.ResultsThree hundred sixty-six patients were matched and compared for quarter 1 to quarter 4 (n = 732, a 28.2 percent match rate); 504 patients were matched for quarter 2 to quarter 4 (n = 1008, a 36.7 percent match rate); 615 patients were matched for quarter 3 to quarter 4 (n = 1230, a 44.8 percent match rate). Increased LACE+ score significantly predicted readmission within 30 days for quarter 1 versus quarter 4 (1.09 percent versus 4.37 percent; p = 0.019), quarter 2 versus quarter 4 (3.57 percent versus 7.34 percent; p = 0.008), and quarter 3 versus quarter 4 (5.04 percent versus 8.13 percent; p = 0.028). Higher LACE+ score also significantly predicted 30-day reoperation for quarter 3 versus quarter 4 (1.30 percent versus 3.90 percent; p = 0.003) and emergency room visits within 30 days for quarter 2 versus quarter 4 (3.17 percent versus 6.75 percent; p = 0.008).ConclusionThe results of this study demonstrate that the LACE+ index may be suitable as a prediction model for patient outcomes in a plastic surgery population.Clinical Question/Level Of EvidenceRisk, II.

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