Luce Edward A, Pierce Charles E
Memphis, Tenn. From the University of Tennessee Health Science Center.
Plast Reconstr Surg. 2015 Sep;136(3):296e-300e. doi: 10.1097/PRS.0000000000001515.
The American College of Surgeons National Surgical Quality Improvement Program is an outcomes-based program with the objective of improving quality of surgical care. With its size and validity, the database has been mined by both general and plastic surgery clinical researchers to provide information for possible risk reduction strategies and patient counseling. However, the 30-day window of the program's database may be inappropriately brief in documentation of complications for some operative procedures. The authors' hypothesis was that the database underestimated complications in alloplastic reconstruction, particularly prosthesis loss.
A cohort of 346 patients and 511 immediate postmastectomy reconstructions was analyzed for reconstruction failure. The inclusion criterion was patients who underwent reconstruction with tissue expanders followed by removal because of complications of infection and/or exposure. The hiatus between surgery (postmastectomy reconstruction) and loss of the tissue expander was recorded. Demographic data and risk factors and postoperative complications of mastectomy skin necrosis and seroma were tabulated.
Fifty-five tissue expanders were explanted in the postoperative period secondary to infection and/or exposure. Of the total, 19 tissue expanders were explanted within 30 days, 36 after the 30-day window (mean, 62 days; median, 43 days). Approximately 65 percent of the tissue expanders destined for eventual loss were still in situ at 30 days. No significant difference existed between the two groups, early and late, regarding risk factors or postoperative mastectomy skin necrosis and seroma.
The American College of Surgeons National Surgical Quality Improvement Program database significantly underestimates the risk of tissue expander loss because of the 30-day limitation in data accrual.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
美国外科医师学会国家外科质量改进计划是一项基于结果的计划，旨在提高外科护理质量。凭借其规模和有效性，普通外科和整形外科临床研究人员都对该数据库进行了挖掘，以提供有关可能的风险降低策略和患者咨询的信息。然而，对于某些手术操作，该计划数据库的30天窗口在并发症记录方面可能过于简短。作者的假设是，该数据库低估了异体植入重建中的并发症，尤其是假体丢失。
分析了一组346例患者和511例乳房切除术后即刻重建病例的重建失败情况。纳入标准是因感染和/或暴露并发症而接受组织扩张器重建并随后取出的患者。记录手术（乳房切除术后重建）与组织扩张器丢失之间的间隔时间。列出人口统计学数据、危险因素以及乳房切除术后皮肤坏死和血清肿的术后并发症。
术后有55个组织扩张器因感染和/或暴露而被取出。其中，19个组织扩张器在30天内被取出，36个在30天窗口之后被取出（平均62天；中位数43天）。最终注定要丢失的组织扩张器中，约65%在30天时仍在位。早期和晚期两组在危险因素或术后乳房切除术后皮肤坏死和血清肿方面没有显著差异。
由于数据积累的30天限制，美国外科医师学会国家外科质量改进计划数据库显著低估了组织扩张器丢失的风险。
临床问题/证据水平：治疗性，III级。
