Divisions of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
J Am Coll Surg. 2013 Dec;217(6):983-90. doi: 10.1016/j.jamcollsurg.2013.07.389. Epub 2013 Aug 21.
Early prosthesis loss is an infrequent but serious complication after breast reconstruction. We assessed perioperative risk factors associated with early device loss after immediate breast reconstruction (IBR) using the ACS-NSQIP datasets.
We reviewed the 2005 to 2011 ACS-NSQIP databases identifying encounters for CPT codes 19357 and 19340. Patients were identified as experiencing a "loss of graft/prosthetic" based on a standard dataset variable. Patients who experienced a device loss were compared with those who did not with respect to perioperative characteristics.
We identified 14,585 patients with an average age of 50.9 ± 10.6 years. A multivariate regression analysis determined that age (>55 years) (odds ratio [OR] 1.66, p = 0.013) (risk score = 1), class II obesity (OR 3.17, p < 0.001) (risk score = 3), class III obesity (OR 2.41, p = 0.014) (risk score = 3), active smoking (OR 2.95, p < 0.001) (risk score = 3), bilateral reconstruction (OR 1.67, p = 0.007) (risk score = 1), and direct-to-implant (DTI) reconstruction (OR 1.69, p = 0.024) (risk score = 1) were associated with early device loss. Odds ratios were used to assign weighted risk scores to each patient, and risk categories were broken into low risk (0 to 1, n = 9,349), intermediate risk (2 to 5, n = 5,001), and high risk (≥ 6, n = 233) groups. The risk of device loss was significantly higher with increased risk score (0.39% vs 1.48% vs 3.86%, p < 0.001).
Early device loss following IBR is a complex multifactorial process related to identifiable preoperative risk factors. This study demonstrated that age, obesity, smoking, bilateral procedures, and DTI reconstructions are associated with increased risk of implant loss.
假体早期丢失是乳房重建后一种罕见但严重的并发症。我们使用 ACS-NSQIP 数据集评估了即刻乳房重建 (IBR) 后与早期器械丢失相关的围手术期危险因素。
我们回顾了 2005 年至 2011 年 ACS-NSQIP 数据库，确定了 CPT 代码 19357 和 19340 的手术。根据标准数据集变量，将经历“移植物/假体丢失”的患者识别为患者。将经历器械丢失的患者与未经历器械丢失的患者进行比较，比较围手术期特征。
我们确定了 14585 名平均年龄为 50.9 ± 10.6 岁的患者。多变量回归分析确定年龄（>55 岁）（比值比 [OR] 1.66，p = 0.013）（风险评分 = 1），II 级肥胖（OR 3.17，p < 0.001）（风险评分 = 3），III 级肥胖（OR 2.41，p = 0.014）（风险评分 = 3），吸烟（OR 2.95，p < 0.001）（风险评分 = 3），双侧重建（OR 1.67，p = 0.007）（风险评分 = 1），以及直接植入（DTI）重建（OR 1.69，p = 0.024）（风险评分 = 1）与早期器械丢失相关。使用比值比为每位患者分配加权风险评分，并将风险类别分为低风险（0 至 1，n = 9349）、中风险（2 至 5，n = 5001）和高风险（≥ 6，n = 233）组。随着风险评分的增加，器械丢失的风险显著增加（0.39%对 1.48%对 3.86%，p < 0.001）。
IBR 后早期器械丢失是一个复杂的多因素过程，与可识别的术前危险因素有关。本研究表明，年龄、肥胖、吸烟、双侧手术和 DTI 重建与植入物丢失风险增加相关。
