Khavanin Nima, Qiu Cecil S, Mlodinow Alexei S, Vu Michael M, Dorfman Robert G, Fine Neil A, Kim John Y S
Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
Division of Plastic and Reconstructive Surgery, Northwestern Memorial Hospital, Chicago, IL, USA.
J Plast Reconstr Aesthet Surg. 2017 Jul;70(7):876-883. doi: 10.1016/j.bjps.2017.04.010. Epub 2017 Apr 23.
The Breast reconstruction Risk Assessment (BRA) Score estimates patient-specific risk for postsurgical complications using an individual's unique combination of preoperative variables. In this report, we externally validate the BRA Score models for surgical site infection, seroma, and explantation in a large sample of intra-institutional patients who underwent prosthetic breast reconstruction.
We reviewed all initiated tissue expander/implant reconstructions by the senior authors from January 2004 to December 2015. BRA Score risk estimates were computed for each patient and compared against observed rates of complications. Hosmer-Lemeshow goodness-of-fit test, concordance statistic, and Brier score were used to assess the calibration, discrimination, and accuracy of the models, respectively.
Of the 1152 patients (1743 breasts) reviewed, 855 patients (1333 breasts) had complete data for BRA-score calculations and were included for analysis. Hosmer-Lemeshow tests for calibration demonstrated a good agreement between observed and predicted outcomes for surgical site infection (SSI) and seroma models (P-values of 0.33 and 0.16, respectively). In contrast, predicted rates of explantation deviated from observed rates (Hosmer-Lemeshow P-value of 0.04). C statistics demonstrated good discrimination for SSI, seroma, and explantation (0.73, 0.69, and 0.78, respectively).
In this external validation study, the BRA Score tissue expander/implant reconstruction models performed with generally good calibration, discrimination, and accuracy. Some weaknesses in certain models were identified as targets for future improvement. Taken together, these analyses validate the clinical utility of the BRA score risk models in predicting 30-day outcomes.
乳房重建风险评估（BRA）评分通过术前变量的独特组合来估计患者术后并发症的个体特异性风险。在本报告中，我们在接受假体乳房重建的大量机构内患者样本中，对BRA评分模型在手术部位感染、血清肿和取出植入物方面进行了外部验证。
我们回顾了2004年1月至2015年12月资深作者发起的所有组织扩张器/植入物重建手术。计算每位患者的BRA评分风险估计值，并与观察到的并发症发生率进行比较。分别使用Hosmer-Lemeshow拟合优度检验、一致性统计量和Brier评分来评估模型的校准、区分度和准确性。
在回顾的1152例患者（1743个乳房）中，855例患者（1333个乳房）有完整数据用于BRA评分计算，并纳入分析。校准的Hosmer-Lemeshow检验表明，手术部位感染（SSI）和血清肿模型的观察结果与预测结果之间具有良好的一致性（P值分别为0.33和0.16）。相比之下，植入物取出的预测率与观察率存在偏差（Hosmer-Lemeshow P值为0.04）。C统计量表明SSI、血清肿和植入物取出具有良好的区分度（分别为0.73、0.69和0.78）。
在这项外部验证研究中，BRA评分组织扩张器/植入物重建模型在校准、区分度和准确性方面总体表现良好。某些模型的一些弱点被确定为未来改进的目标。综合来看，这些分析验证了BRA评分风险模型在预测30天结局方面的临床实用性。
