Cordeiro Erin, Zhong Toni, Jackson Timothy, Cil Tulin
Division of General Surgery, The Ottawa Hospital, Ottawa, ON, Canada.
Division of Plastic and Reconstructive Surgery, University Health Network, Toronto, ON, Canada; Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, ON, Canada.
Am J Surg. 2017 Sep;214(3):495-500. doi: 10.1016/j.amjsurg.2016.11.015. Epub 2016 Nov 12.
We sought to examine the safety of same-day breast reconstructive (BR) surgery.
An analysis of the American College of Surgeons, National Surgical Quality Improvement Program (ACS-NSQIP) files was performed. Patients undergoing BR for breast cancer were examined, excluding those with high-risk co-morbidities or concurrent surgery. A propensity score was calculated and a multivariable logistic regression analysis was used to calculate the difference in 30-day complications between those undergoing SDS versus longer hospital stay.
The study consisted of 21,539 patients; 17,449 had implant and 4090 had autologous breast reconstruction. 1195 (5.5%) underwent SDS, whereas 20,344 (94.5%) were admitted at least overnight. On unadjusted analysis, the rate of post-operative complications was nearly three times higher in those admitted compared to those undergoing SDS (6.7% vs. 2.5%; p < 0.001). On propensity score adjusted multivariable regression there was no significant difference in complications amongst those undergoing SDS versus staying in hospital (OR 1.4 (95%CI: 0.9, 2.2)).
These results suggest that admitting BR patients does not prevent short-term complications and same day BR surgery is safe when co-morbidities are accounted for.
我们试图研究同日乳房重建（BR）手术的安全性。
对美国外科医师学会国家外科质量改进计划（ACS-NSQIP）的档案进行分析。对接受乳腺癌BR手术的患者进行检查，排除有高危合并症或同期手术的患者。计算倾向评分，并使用多变量逻辑回归分析来计算同日手术（SDS）患者与住院时间较长患者之间30天并发症的差异。
该研究包括21539例患者；17449例行植入物乳房重建，4090例行自体乳房重建。1195例（5.5%）接受了SDS，而20344例（94.5%）至少住院过夜。未经调整的分析显示，住院患者的术后并发症发生率几乎是接受SDS患者的三倍（6.7%对2.5%；p<0.001）。在倾向评分调整的多变量回归分析中，接受SDS与住院患者之间的并发症无显著差异（比值比1.4（95%置信区间：0.9，2.2））。
这些结果表明，收治BR患者并不能预防短期并发症，在考虑合并症的情况下，同日BR手术是安全的。
