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首页> 外文期刊>Journal of plastic, reconstructive & aesthetic surgery: JPRAS >Comparing thirty-day outcomes in prosthetic and autologous breast reconstruction: A multivariate analysis of 13,082 patients?
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Comparing thirty-day outcomes in prosthetic and autologous breast reconstruction: A multivariate analysis of 13,082 patients?

机译：比较假体和自体乳房再造的30天结果：13,082例患者的多变量分析？

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Background There is a paucity of multi-institutional data that directly compares short term outcomes of autologous and prosthetic breast reconstruction. The National Surgical Quality Improvement Program provides a unique data platform for evaluating peri-operative outcomes of these two main categories of breast reconstruction. It has detailed data from nearly 250 hospitals and over 13,000 patients. We performed risk-adjusted analysis of prosthetic and autologous breast reconstruction to compare 30-day morbidity outcomes. Methods Patients who underwent prosthetic breast reconstruction or autologous tissue reconstruction from 2006 to 2010 were identified using operation descriptions. Over 240 tracked variables were extracted for patients undergoing breast reconstruction. Thirty-day postoperative outcomes were compared, and subgroup analysis was performed on the autologous population to describe outcomes of specific flap procedures. Reconstruction was analyzed as an independent risk factor for specific complications, with propensity scores used to help standardize compared patient populations. Regression analyses were performed using SPSS (version 20.0, Chicago, IL). Results A total of 13,082 patients underwent breast reconstruction; 9786 patients received prosthetic reconstruction and 3296 received autologous reconstruction. Within the autologous cohort, 1608 (48.8%) patients underwent a pedicle TRAM flap, 1079 (32.7%) had a LD flap, and 609 (18.5%) received a free flap. Autologous reconstruction patients had higher rates of overall complications (12.47% vs 5.38%, p <.001), wound infection (5.46% vs 3.45%, p <.001), prosthesis/flap failure (3.13% vs 0.85%, p <.001), and reoperation (9.59% vs 6.76%, p <.001). Risk-adjusted multivariate analysis also showed autologous reconstruction to be a significant independent predictor of specific short term outcomes. Conclusions Using risk-adjusted models of a large multi-institutional database, we found that - relative to prosthetic reconstruction - autologous reconstruction had higher rates of 30-day overall complications, wound infection, prosthesis/flap failure, and reoperation. This may be due, in part, to a concomitant increase in operative time and higher case complexity. Taken with other reports such as NMBRA, this study helps to educate patients and surgeons alike on potential, comparative complications during the perioperative period.
机译：背景技术很少有多机构数据可以直接比较自体和假体乳房重建的短期结果。国家外科手术质量改善计划提供了一个独特的数据平台，用于评估这两种主要乳房重建术的围手术期结果。它具有来自将近250家医院和13,000多名患者的详细数据。我们对假体和自体乳房再造进行了风险调整后的分析，以比较30天的发病率。方法回顾性分析2006年至2010年行人工乳房再造或自体组织再造的患者。为进行乳房再造的患者提取了240多个跟踪变量。比较了术后30天的结果，并对自体人群进行了亚组分析，以描述特定皮瓣手术的结果。重建被分析为特定并发症的独立危险因素，倾向得分用于帮助标准化比较患者人群。使用SPSS（20.0版，伊利诺伊州芝加哥）进行回归分析。结果共有13082例患者接受了乳房再造。 9786例患者接受了假体重建，3296例接受了自体重建。在自体队列中，有1608名（48.8％）患者行了蒂TRAM皮瓣，1079名（32.7％）行了LD皮瓣，而609名（18.5％）进行了游离皮瓣。自体重建患者的总体并发症发生率较高（12.47％vs 5.38％，p <.001），伤口感染（5.46％vs 3.45％，p <.001），假体/瓣失败（3.13％vs 0.85％，p < .001）和再手术（9.59％比6.76％，p <.001）。风险调整后的多元分析还显示，自体重建是特定短期结果的重要独立预测因子。结论使用大型多机构数据库的风险调整模型，我们发现-与假体重建相比-自体重建具有较高的30天总体并发症，伤口感染，假体/皮瓣衰竭和再手术率。这可能部分是由于手术时间的增加和案件复杂性的增加。结合NMBRA等其他报道，该研究有助于对患者和外科医生进行围手术期潜在的比较并发症的教育。

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