New Cross Hospital, Royal Wolverhampton Hospitals NHS Trust, Wednesfield Way, Wolverhampton, WV10 0QP, UK.
Clinical Trials Research Centre (CTRC), North West Hub for Trials Methodology/University of Liverpool, Liverpool, L12 2AP, UK.
Eur J Surg Oncol. 2018 May;44(5):708-716. doi: 10.1016/j.ejso.2018.01.098. Epub 2018 Feb 7.
The 2008 National Mastectomy and Breast Reconstruction Audit demonstrated marked variation in the practice and outcomes of breast reconstruction in the UK. To standardise practice and improve outcomes for patients, the British professional associations developed best-practice guidelines with specific guidance for newer mesh-assisted implant-based techniques. We explored the degree of uptake of best-practice guidelines within units performing implant-based reconstruction (IBBR) as the first phase of the implant Breast Reconstruction Evaluation (iBRA) study.
A questionnaire developed by the iBRA Steering Group was completed by trainee and consultant leads at breast and plastic surgical units across the UK. Simple summary statistics were calculated for each survey item to assess compliance with current best-practice guidelines.
81 units from 79 NHS Trusts completed the questionnaire. Marked variation was observed in adherence to guidelines, especially those relating to clinical governance and infection prevention strategies. Less than half (n = 28, 47%) of units obtained local clinical governance board approval prior to offering new mesh-based techniques and prospective audit of the clinical, cosmetic and patient-reported outcomes of surgery was infrequent. Most units screened for methicillin-resistant staphylococcus aureus prior to surgery but fewer than 1 in 3 screened for methicillin-sensitive strains. Laminar-flow theatres (recommended for IBBR) were not widely-available with less than 1 in 5 units having regular access. Peri-operative antibiotics were widely-used, but the type and duration were highly-variable.
The iBRA national practice questionnaire has demonstrated variation in reported practice and adherence to IBBR guidelines. High-quality evidence is urgently required to inform best practice.
2008 年全国乳房切除术和乳房重建审计显示，英国乳房重建的实践和结果存在明显差异。为了规范实践并改善患者的结果，英国专业协会制定了最佳实践指南，为新的基于网片的植入物技术提供了具体指导。我们在进行植入物乳房重建（IBBR）的单位中探索了最佳实践指南的采用程度，这是植入物乳房重建评估（iBRA）研究的第一阶段。
由 iBRA 指导小组开发的问卷由英国各地乳房和整形手术单位的学员和顾问负责人完成。对每个调查项目进行简单的汇总统计，以评估对当前最佳实践指南的遵守情况。
来自 79 个 NHS 信托基金的 81 个单位完成了问卷。在遵守指南方面存在明显差异，特别是在临床治理和感染预防策略方面。只有不到一半（n=28，47%）的单位在提供新的基于网片的技术之前获得了当地临床治理委员会的批准，并且很少对手术的临床、美容和患者报告的结果进行前瞻性审核。大多数单位在手术前筛查耐甲氧西林金黄色葡萄球菌，但不到三分之一的单位筛查耐甲氧西林敏感株。层流手术室（推荐用于 IBBR）并不广泛可用，不到五分之一的单位有定期使用。围手术期抗生素广泛使用，但类型和持续时间差异很大。
iBRA 全国实践问卷显示报告的实践和对 IBBR 指南的遵守情况存在差异。迫切需要高质量的证据来为最佳实践提供信息。
