Roberts Amanda, Baxter Nancy, Camacho Ximena, Lau Cindy, Zhong Toni
Department of Surgery, University of Toronto, Toronto, ON, Canada,
Ann Surg Oncol. 2015 Oct;22(10):3302-7. doi: 10.1245/s10434-015-4716-8. Epub 2015 Jul 23.
Postmastectomy breast reconstruction (PMBR) aims to surgically restore a breast mound following mastectomy. However, additional surgical procedures after PMBR can lead to increased postsurgical morbidity and healthcare utilization. The primary purpose of our study was to determine the overall population-based reoperation rates following PMBR in Ontario, Canada.
We conducted a population-based retrospective cohort study that included women aged 18-65 years who underwent a prophylactic or therapeutic mastectomy with immediate or delayed PMBR between April 1, 2002 and March 31, 2008. Reoperations to the breast or donor site used for reconstruction were identified using the Ontario Health Insurance Plan billing codes submitted by general or plastic surgeons. Reoperations were categorized as anticipated, unanticipated major, unanticipated minor, or oncologic. Patients were followed from the date of their PMBR to March 31, 2013, or death.
Overall, 3972 women underwent PMBR between April 1, 2002 and March 31, 2008. Among them, 3504 (88%) underwent at least one reoperation during an average follow-up of 5.1 years. The median number of procedures per patient was two (mean 2.4, range 0-26). One of ten patients had three or more unanticipated major reoperations during the follow-up period.
Our results provide the first long-term population-level data on the current state of PMBR reoperation rates. The results from this study will inform patient-physician surgical decision-making and provide quantitative expectations of morbidity related to PMBR.
乳房切除术后乳房重建(PMBR)旨在通过手术在乳房切除术后恢复乳房外形。然而,PMBR后的额外手术操作可能会导致术后发病率增加和医疗资源利用增多。我们研究的主要目的是确定加拿大安大略省基于总体人群的PMBR术后再次手术率。
我们进行了一项基于人群的回顾性队列研究,纳入了年龄在18至65岁之间、在2002年4月1日至2008年3月31日期间接受预防性或治疗性乳房切除术并立即或延迟进行PMBR的女性。通过普通外科医生或整形外科医生提交的安大略省医疗保险计划计费代码来确定对用于重建的乳房或供区进行的再次手术。再次手术分为预期性、意外重大、意外轻微或肿瘤性。从患者进行PMBR之日起至2013年3月31日或死亡进行随访。
总体而言,在2002年4月1日至2008年3月31日期间,3972名女性接受了PMBR。其中,3504名(88%)在平均5.1年的随访期间至少接受了一次再次手术。每位患者手术的中位数为两次(平均2.4次,范围为0至26次)。在随访期间,每十名患者中有一名进行了三次或更多次意外重大再次手术。
我们的结果提供了关于PMBR再次手术率现状的首批长期人群水平数据。本研究结果将为医患手术决策提供参考,并提供与PMBR相关发病率的定量预期