Evaluation Unit, Hospital Costa del Sol and CIBER Epidemiología y Salud Pública, Marbella, Spain.
Int J Technol Assess Health Care. 2011 Oct;27(4):298-304. doi: 10.1017/S026646231100047X.
Immediate post-mastectomy breast reconstruction (IBR) is a procedure that has proven advantages, but it also entails risks. The aim of this study was to identify risk factors for reconstruction failure.
A review was made of all the IBR carried out at a general hospital from 2002 to 2009. Retrospective information was obtained about postoperative complications and the characteristics of patients and treatments applied. The minimum follow-up period was 9 months. Cox's regression analysis was performed on the variables related to the reconstruction failure requiring the removal of the prosthesis, with an explanatory model in which all the study variables were introduced and a predictive model that contained only the variables known before the intervention.
A total of 115 IRB interventions carried out on 112 women with breast cancer were analyzed. The mean follow-up period was 25.5 months. In sixty cases (52.2 percent), there were no complications; in sixteen cases (13.9 percent) minor complications appeared, and in 39 (33.9 percent) the complications were moderate. In twenty-six cases (22.6 percent), a reconstruction failure occurred. Cox's regression model revealed that the reconstruction failures were related to the patient's age (Hazard Ratio 1.08), to neoadjuvant chemotherapy (HR 6.24) and to postoperative tamoxifen (HR 3.10). The predictive model included the age of the patient (HR 1.05) and the use of neoadjuvant chemotherapy (HR 5.11).
A significant proportion of the patients receiving IBR developed reconstruction failure. Multivariate analysis identified three variables related to this complication, two of which were known before the intervention.
即刻乳房重建（IBR）是一种已被证实具有优势的手术方法，但也存在风险。本研究旨在确定重建失败的危险因素。
对 2002 年至 2009 年期间在一家综合医院进行的所有 IBR 进行了回顾性研究。获取了术后并发症以及患者和治疗特点的回顾性信息。随访时间最短为 9 个月。对与需要去除假体的重建失败相关的变量进行 Cox 回归分析，建立解释模型，其中引入了所有研究变量，并建立了仅包含干预前已知变量的预测模型。
共分析了 112 例乳腺癌女性的 115 例 IBR 干预。平均随访时间为 25.5 个月。在 60 例（52.2%）中无并发症；16 例（13.9%）出现轻微并发症，39 例（33.9%）为中度并发症。26 例（22.6%）发生重建失败。Cox 回归模型显示，重建失败与患者年龄（危险比 1.08）、新辅助化疗（HR 6.24）和术后他莫昔芬（HR 3.10）有关。预测模型包括患者年龄（HR 1.05）和新辅助化疗的使用（HR 5.11）。
相当一部分接受 IBR 的患者发生了重建失败。多变量分析确定了与该并发症相关的三个变量，其中两个在干预前已知。
