影响乳房重建手术等待时间的因素。

Factors affecting surgical wait times for breast reconstruction.

作者信息

Boyd Kirsty U, Temple Claire Lf, Ross Douglas C

机构信息

Division of Plastic Surgery, Department of Surgery, University of Western Ontario;

出版信息

Can J Plast Surg. 2010 Fall;18(3):107-11.

PMID:21886436

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2940968/

Abstract

OBJECTIVE

To examine factors that affect wait times for women seeking breast reconstruction at a Canadian academic centre.

METHODS

A retrospective audit of 57 women seeking breast reconstruction over a three-year period was completed. Comparisons of wait times were made considering the surgical pathology, timing of reconstruction (immediate versus delayed), urgency of pathology, method of reconstruction (implant versus autologous) and the number of surgeons involved. Specifically, the wait times from referral to specialist consultation, consultation to surgery, and referral to surgery were examined.

RESULTS

WOMEN WITH ACTIVE CANCER (DUCTAL CARCINOMA IN SITU: 43 days, invasive cancer: 40 days) had shorter wait times compared with those who had no active cancer (benign/high risk: 242 days, previously treated cancer: 343 days) (P<0.05). Women seeking delayed reconstruction had longer wait times (359 days) from referral to surgery than women seeking immediate reconstruction (98 days) (P<0.0001). Women seeking reconstruction at the time of mastectomy, with benign/high-risk disease, waited longer (242 days) than those with ductal carcinoma in situ (43 days) or invasive cancer (40 days) (P<0.001). Wait times for autologous free tissue transfer (213 days) were not significantly longer compared with implant reconstruction (116 days) (P=0.27). Women with acute cancer experienced similar wait times for implant reconstruction (44 days) as for a free tissue transfer (56 days) (P=0.46). Women with no acute cancer had similar wait times for implant (239 days) as free tissue transfer (369 days) (P=0.25). Patients requiring only plastic surgeons involved in the reconstructive effort waited longer (one surgeon: 299 days, two surgeons: 550 days) than patients requiring either two plastic surgeons and one general surgeon (130 days) or one plastic surgeon and one general surgeon (82 days) (P<0.05). Although more coordination is required with three surgeons, this is frequently associated with a diagnosis of acute cancer and, therefore, wait times are shorter.

摘要

目的

研究影响加拿大一家学术中心寻求乳房重建的女性等待时间的因素。

方法

对57名在三年期间寻求乳房重建的女性进行了回顾性审计。根据手术病理、重建时机（即刻与延迟）、病理紧急程度、重建方法（植入物与自体组织）以及参与手术的外科医生数量对等待时间进行了比较。具体而言，研究了从转诊到专科会诊、会诊到手术以及转诊到手术的等待时间。

结果

患有活动性癌症的女性（导管原位癌：43天，浸润性癌：40天）的等待时间比没有活动性癌症的女性（良性/高风险：242天，既往接受过治疗的癌症：343天）短（P<0.05）。寻求延迟重建的女性从转诊到手术的等待时间（359天）比寻求即刻重建的女性（98天）长（P<0.0001）。在乳房切除术时寻求重建且患有良性/高风险疾病的女性等待时间（242天）比患有导管原位癌（43天）或浸润性癌（40天）的女性长（P<0.001）。自体游离组织移植的等待时间（213天）与植入物重建的等待时间（116天）相比没有显著延长（P=0.27）。患有急性癌症的女性进行植入物重建的等待时间（44天）与游离组织移植的等待时间（56天）相似（P=0.46）。没有急性癌症的女性进行植入物重建的等待时间（239天）与游离组织移植的等待时间（369天）相似（P=0.25）。仅需要整形外科医生参与重建工作的患者等待时间更长（一名外科医生：299天，两名外科医生：550天），比需要两名整形外科医生和一名普通外科医生（130天）或一名整形外科医生和一名普通外科医生（82天）的患者长（P<0.05）。虽然三名外科医生之间需要更多协调，但这通常与急性癌症的诊断相关，因此等待时间较短。