Wink Jason D, Fischer John P, Nelson Jonas A, Serletti Joseph M, Wu Liza C
Division of Plastic Surgery, Hospital of the University of Pennsylvania , Philadelphia, PA , USA.
J Plast Surg Hand Surg. 2014 Dec;48(6):375-81. doi: 10.3109/2000656X.2014.899240. Epub 2014 Mar 27.
There is continued debate about the outcomes of direct-to-implant (DTI) breast reconstruction when compared to a two-stage expander/implant approach. The purpose of this study was to examine outcomes after DTI reconstruction utilising the American College of Surgeons-National Surgical Quality Improvement (ACS-NSQIP) database. This study reviewed the 2005-2010 ACS-NSQIP databases identifying encounters with common procedural terminology codes for DTI (19340) (mastectomy and immediate implant placement). A composite variable of "major surgical complications" (deep infection, return to OR, device loss) was used as the dependent variable in the analysis. Logistic regression analysis was performed to assess for pre- and intraoperative factors associated with the occurrence of "major surgical complications". Overall, 1612 patients underwent one stage, DTI reconstruction with an average age of 50.8 ± 10.7 years with a body mass index (BMI) (kg/m2) of 26.9 ± 6.3 kg/m2. The incidence of major surgical complications was 9%. A multivariate regression analysis revealed obesity (OR = 1.54, p = 0.03), active smoking (OR = 1.60, p = 0.044), and prolonged operative time (>1 SD above average) (OR = 1.88, p = 0.002) were associated with surgical morbidity. The results of the analysis emphasize that DTI-based breast reconstruction can be an excellent option for a specific group of patients. Careful pre-operative patient selection will optimise outcomes, and caution must be used in assessing suitability of DTI in obese patients and active smokers.
与两阶段扩张器/植入物方法相比，直接植入式（DTI）乳房重建的效果一直存在争议。本研究的目的是利用美国外科医师学会-国家外科质量改进（ACS-NSQIP）数据库来检查DTI重建后的效果。本研究回顾了2005年至2010年的ACS-NSQIP数据库，识别出使用DTI常见手术术语代码（19340）（乳房切除术和即刻植入物放置）的病例。分析中使用“主要手术并发症”（深部感染、返回手术室、植入物丢失）的复合变量作为因变量。进行逻辑回归分析以评估与“主要手术并发症”发生相关的术前和术中因素。总体而言，1612例患者接受了一期DTI重建，平均年龄为50.8±10.7岁，体重指数（BMI）（kg/m²）为26.9±6.3kg/m²。主要手术并发症的发生率为9%。多变量回归分析显示，肥胖（OR = 1.54，p = 0.03）、主动吸烟（OR = 1.60，p = 0.044）和手术时间延长（高于平均水平1个标准差以上）（OR = 1.88，p = 0.002）与手术并发症相关。分析结果强调，基于DTI的乳房重建对于特定患者群体可能是一个极佳的选择。术前仔细选择患者将优化手术效果，并且在评估肥胖患者和主动吸烟者进行DTI的适用性时必须谨慎。
