Masoomi Hossein, Paydar Keyianoosh Z, Wirth Garrett A, Aly Al, Kobayashi Mark R, Evans Gregory R D
From the Aesthetic and of Plastic Surgery Institute, University of California, Irvine Medical Center, Orange, CA.
Ann Plast Surg. 2014 Jan;72(1):30-3. doi: 10.1097/SAP.0000000000000003.
Venous thromboembolism (VTE) can be a significant cause of morbidity and mortality in autologous breast reconstruction surgery. The aim of this study was to evaluate the effect of patient characteristics, comorbidities, payer type, reconstruction type, reconstruction timing, radiation, chemotherapy, and teaching status of hospital on VTE (deep venous thrombosis and/or pulmonary embolism) in autologous breast reconstructive surgery.
Using the Nationwide Inpatient Sample (NIS) database, we examined the clinical data of patients who underwent autologous breast reconstructive surgery in 2009 to 2010 in the United States. Univariate and multivariate regression analyses were performed to identify factors predictive of in-hospital VTE.
A total of 35,883 patients underwent autologous breast reconstructive surgery during this period. Overall rate of VTE was 0.13%. The highest rate of VTE (0.26%) was observed in pedicled transverse rectus abdominis myocutaneous flap. Patients who experienced VTE had significantly longer mean hospital stay (11.6 vs 3.9 days; P < 0.001) and higher mean total hospital charges ($146,432 vs $61,794; P < 0.001) compared with non-VTE patients; however, there was no significant difference observed in mortality rate (VTE, 0.0% vs non-VTE, 0.04%; P = 0.886). Using multivariate regression analysis, immediate reconstruction after mastectomy (adjusted odds ratio [AOR], 5.4), older than 65 years (AOR, 4.2), obesity (AOR, 3.7), history of chemotherapy (AOR, 3.5), and chronic lung disease (AOR, 2.5) were associated with higher risk of VTE. There was no association between race, payer type, diabetes, hypertension, liver disease, congestive heart failure, peripheral vascular disease, chronic kidney disease, smoking, reconstruction type, radiation, or teaching status of hospital on VTE.
In patients undergoing autologous breast reconstruction surgery, immediate reconstruction, older than 65 years, obesity, history of chemotherapy, and chronic lung disease are all independent predictors of higher VTE. Surgeons should consider these factors and use appropriate prophylaxis to minimize the risk of VTE development.
静脉血栓栓塞症（VTE）可能是自体乳房重建手术中发病和死亡的重要原因。本研究的目的是评估患者特征、合并症、付款人类型、重建类型、重建时机、放疗、化疗以及医院教学状况对自体乳房重建手术中VTE（深静脉血栓形成和/或肺栓塞）的影响。
利用全国住院患者样本（NIS）数据库，我们研究了2009年至2010年在美国接受自体乳房重建手术患者的临床资料。进行单因素和多因素回归分析以确定住院VTE的预测因素。
在此期间共有35883例患者接受了自体乳房重建手术。VTE的总体发生率为0.13%。在带蒂腹直肌肌皮瓣中观察到最高的VTE发生率（0.26%）。与非VTE患者相比，发生VTE的患者平均住院时间显著更长（11.6天对3.9天；P<0.001），平均总住院费用更高（146432美元对61794美元；P<0.001）；然而，死亡率没有显著差异（VTE为0.0%，非VTE为0.04%；P = 0.886）。使用多因素回归分析，乳房切除术后立即重建（调整优势比[AOR]，5.4）、年龄大于65岁（AOR，4.2）、肥胖（AOR，3.7）、化疗史（AOR，3.5）和慢性肺病（AOR，2.5）与VTE风险较高相关。种族、付款人类型、糖尿病、高血压、肝病、充血性心力衰竭、外周血管疾病、慢性肾病、吸烟、重建类型、放疗或医院教学状况与VTE之间没有关联。
在接受自体乳房重建手术的患者中，立即重建、年龄大于65岁、肥胖、化疗史和慢性肺病都是VTE发生率较高的独立预测因素。外科医生应考虑这些因素并采用适当的预防措施以尽量降低VTE发生的风险。
