Chen Austin D, Kamali Parisa, Chattha Anmol S, Bucknor Alexandra, Cohen Justin B, Bletsis Patrick P, Flecha-Hirsch Renata, Tobias Adam M, Lee Bernard T, Lin Samuel J
Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.; and Department of Plastic, Reconstructive and Hand Surgery, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands.
Plast Reconstr Surg Glob Open. 2018 Mar 6;6(3):e1643. doi: 10.1097/GOX.0000000000001643. eCollection 2018 Mar.
The aim was to assess reliability of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) 30-day perioperative outcomes and complications for immediate, free-tissue transfer breast reconstruction by direct comparisons with our 30-day and overall institutional data, and assessing those that occur after 30 days.
Data were retrieved for consecutive immediate, free-tissue transfer breast reconstruction patients from a single-institution database (2010-2015) and the ACS-NSQIP (2011-2014). Multiple logistic regressions were performed to compare adjusted outcomes between the 2 datasets.
For institutional versus ACS-NSQIP outcomes, there were no significant differences in surgical-site infection (SSI; 30-day, 3.6% versus 4.1%, = 0.818; overall, 5.3% versus 4.1%, = 0.198), wound disruption (WD; 30-day, 1.3% versus 1.5%, = 0.526; overall, 2.3% versus 1.5%, = 0.560), or unplanned readmission (URA; 30-day, 2.3% versus 3.3%, = 0.714; overall, 4.6% versus 3.3%, = 0.061). However, the ACS-NSQIP reported a significantly higher unplanned reoperation (URO) rate (30-day, 3.6% versus 9.5%, < 0.001; overall, 5.3% versus 9.5%, = 0.025). Institutional complications consisted of 5.3% SSI, 2.3% WD, 5.3% URO, and 4.6% URA, of which 25.0% SSI, 28.6% WD, 12.5% URO, and 7.1% URA occurred at 30-60 days, and 6.3% SSI, 14.3% WD, 18.8% URO, and 42.9% URA occurred after 60 days.
For immediate, free-tissue breast reconstruction, the ACS-NSQIP may be reliable for monitoring and comparing SSI, WD, URO, and URA rates. However, clinicians may find it useful to understand limitations of the ACS-NSQIP for complications and risk factors, as it may underreport complications occurring beyond 30 days.
目的是通过与我们机构的30天及总体数据进行直接比较，评估美国外科医师学会国家外科质量改进计划（ACS - NSQIP）中30天围手术期结局和并发症对于即刻游离组织移植乳房重建的可靠性，并评估那些在30天后发生的情况。
从一个单一机构数据库（2010 - 2015年）和ACS - NSQIP（2011 - 2014年）中检索连续的即刻游离组织移植乳房重建患者的数据。进行多因素逻辑回归以比较两个数据集之间的调整后结局。
对于机构与ACS - NSQIP的结局，手术部位感染（SSI；30天，3.6%对4.1%，P = 0.818；总体，5.3%对4.1%，P = 0.198）、伤口裂开（WD；30天，1.3%对1.5%，P = 0.526；总体，2.3%对1.5%，P = 0.560）或计划外再入院（URA；30天，2.3%对3.3%，P = 0.714；总体，4.6%对3.3%，P = 0.061）方面无显著差异。然而，ACS - NSQIP报告的计划外再次手术（URO）率显著更高（30天，3.6%对9.5%，P < 0.001；总体，5.3%对9.5%，P = 0.025）。机构并发症包括5.3%的SSI、2.3%的WD、5.3%的URO和4.6%的URA，其中25.0%的SSI、28.6%的WD、12.5%的URO和7.1%的URA发生在30 - 60天，6.3%的SSI、14.3%的WD、18.8%的URO和42.9%的URA发生在60天后。
对于即刻游离组织乳房重建，ACS - NSQIP在监测和比较SSI、WD、URO和URA发生率方面可能是可靠的。然而，临床医生可能会发现了解ACS - NSQIP在并发症和危险因素方面的局限性是有用的，因为它可能漏报30天后发生的并发症。
