Nelson Jonas A, Chung Cyndi U, Fischer John P, Kanchwala Suhail K, Serletti Joseph M, Wu Liza C
Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
J Plast Reconstr Aesthet Surg. 2015 Apr;68(4):531-9. doi: 10.1016/j.bjps.2014.11.017. Epub 2014 Nov 28.
Delayed wound healing is costly to the breast reconstruction patient and the health care infrastructure. The purpose of this study is to identify potentially modifiable risk factors and to create a model to assess patient risk of these complications.
We performed a retrospective study of all free autologous reconstructions at a single institution (2005-2011). Patients with delayed wound healing (operative wounds requiring dressing changes for longer than 3 weeks) were compared to patients with normal healing with respect to history and case characteristics. A risk model was developed to stratify patients based on the multivariate logistic regression results.
Delayed wound healing impacted 297 (44%) of 682 patients. These patients were older (p = 0.02), with higher BMI(p < 0.0001), and higher rates of medical comorbidities (p < 0.001), active smoking (p = 0.02) and bilateral reconstruction (p = 0.02). They received a lower rate/kg of fluid resuscitation intraoperatively (p = 0.001) and more commonly received vasopressors (p = 0.004), with a greater total reconstructive cost (p = 0.003). A regression demonstrated that progressive obesity, smoking, bilateral reconstruction, and utilization of vasopressors were associated with delayed healing (p < 0.05). The final model, with three risk groups (low, intermediate and high) demonstrated that high risk patients have an 86% risk of wound healing complications, compared to a 33% risk in patients with few risk factors.
While patient disease remains a major predictor of wound complications, potentially modifiable variables including smoking and vasopressor administration impacted this complication. Utilizing the simple model to preoperatively assess patient risk, targeted measures can be undertaken with the goal of ultimately reducing wound healing complications and cost.
伤口愈合延迟对乳房重建患者和医疗保健基础设施而言成本高昂。本研究的目的是识别潜在的可改变风险因素，并创建一个模型来评估患者发生这些并发症的风险。
我们对单一机构（2005 - 2011年）的所有自体游离组织重建手术进行了回顾性研究。将伤口愈合延迟（手术伤口需要换药超过3周）的患者与愈合正常的患者在病史和病例特征方面进行比较。根据多因素逻辑回归结果开发了一个风险模型，对患者进行分层。
682例患者中有297例（44%）出现伤口愈合延迟。这些患者年龄较大（p = 0.02），体重指数较高（p < 0.0001），合并症发生率较高（p < 0.001），当前吸烟者比例较高（p = 0.02），双侧重建率较高（p = 0.02）。他们术中每千克体重接受的液体复苏量较低（p = 0.001），更常使用血管加压药（p = 0.004），总重建成本更高（p = 0.003）。回归分析表明，进行性肥胖、吸烟、双侧重建和使用血管加压药与愈合延迟相关（p < 0.05）。最终模型分为三个风险组（低、中、高），结果显示，高风险患者发生伤口愈合并发症的风险为86%，而风险因素较少的患者风险为33%。
虽然患者疾病仍然是伤口并发症的主要预测因素，但包括吸烟和使用血管加压药在内的潜在可改变变量会影响这一并发症。利用这个简单模型术前评估患者风险，可以采取针对性措施，最终目标是减少伤口愈合并发症和成本。
