Golpanian Samuel, Gerth David J, Tashiro Jun, Thaller Seth R
Division of Plastic, Aesthetic & Reconstructive Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami, Clinical Research Building, 1120 N.W. 14th Street, 4th Floor, Miami, FL, 33136, USA.
Aesthetic Plast Surg. 2016 Dec;40(6):869-876. doi: 10.1007/s00266-016-0704-z. Epub 2016 Oct 14.
Conventionally, free transverse rectus abdominis myocutaneous (fTRAM) flap breast reconstruction has been associated with decreased donor site morbidity and improved flap inset. However, clinical success depends upon more sophisticated technical expertise and facilities. This study aims to characterize postoperative outcomes undergoing free versus pedicled TRAM (pTRAM) flap breast reconstruction.
Nationwide inpatient sample database (2008-2011) was reviewed for cases of fTRAM (ICD-9-CM 85.73) and pTRAM (85.72) breast reconstruction. Inclusion criteria were females undergoing pTRAM or fTRAM breast reconstruction; males were excluded. We examined demographics, hospital setting, insurance information, patient income, and comorbidities. Clinical endpoints included postoperative complications, length-of-stay (LOS), and total charges (TC). Bivariate/multivariate analyses were performed to identify independent risk factors associated with increased complications and resource utilization.
Overall, 21,655 cases were captured. Seventy-percent were Caucasian, 95 % insured, and 72 % treated in an urban teaching hospital. There were 9 pTRAM and 6 fTRAM in-hospital mortalities. On bivariate analysis, the fTRAM cohort was more likely to be obese (OR 1.2), undergo revision (OR 5.9), require hemorrhage control (OR 5.7), suffer hematoma complications (OR 1.9), or wound infection (OR 1.8) (p < 0.003). The pTRAM cohort was more likely to suffer pneumonia (OR 1.6) and pulmonary embolism (OR 2.0) (p < 0.004). Reconstruction type did not affect risk of flap loss or seroma occurrence. TC were higher with fTRAM (p < 0.001). LOS was not affected by procedure type. On risk-adjusted multivariate analysis, fTRAM was an independent risk factor for increased LOS (OR 1.6), TC (OR 1.8), and postoperative complications (OR 1.3) (p < 0.001).
Free TRAM has an increased risk of postoperative complications and resource utilization versus pTRAM on the current largest risk-adjusted analysis. Further analyses are required to elucidate additional factors influencing outcomes following these procedures.
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传统上，游离腹直肌肌皮瓣（fTRAM）乳房重建术与供区并发症减少及皮瓣植入效果改善相关。然而，临床成功取决于更复杂的技术专长和设施。本研究旨在描述接受游离与带蒂腹直肌肌皮瓣（pTRAM）乳房重建术的术后结果。
回顾全国住院患者样本数据库（2008 - 2011年）中fTRAM（国际疾病分类第九版临床修订本[ICD - 9 - CM]85.73）和pTRAM（85.72）乳房重建的病例。纳入标准为接受pTRAM或fTRAM乳房重建的女性；男性排除在外。我们检查了人口统计学、医院环境、保险信息、患者收入和合并症。临床终点包括术后并发症、住院时间（LOS）和总费用（TC）。进行双变量/多变量分析以确定与并发症增加和资源利用相关的独立危险因素。
总体而言，共收集到21,655例病例。70%为白种人，95%有保险，72%在城市教学医院接受治疗。有9例pTRAM和6例fTRAM住院死亡病例。双变量分析显示，fTRAM队列更易肥胖（比值比[OR]1.2）、接受修复手术（OR 5.9）、需要控制出血（OR 5.7）、发生血肿并发症（OR 1.9）或伤口感染（OR 1.8）（p < 0.003）。pTRAM队列更易发生肺炎（OR 1.6）和肺栓塞（OR 2.0）（p < 0.004）。重建类型不影响皮瓣丢失或血清肿发生风险。fTRAM的TC更高（p < 0.001）。LOS不受手术类型影响。在风险调整多变量分析中，fTRAM是LOS增加（OR 1.6）、TC增加（OR 1.8）和术后并发症增加（OR 1.3）的独立危险因素（p < 0.001）。
在当前最大规模的风险调整分析中，与pTRAM相比，游离腹直肌肌皮瓣术后并发症和资源利用风险增加。需要进一步分析以阐明影响这些手术术后结果的其他因素。
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