糖尿病对乳房切除术和假体植入式乳房重建术后 30 天并发症的影响。

Impact of Diabetes on 30-Day Complications in Mastectomy and Implant-Based Breast Reconstruction.

机构信息

Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, New York.

出版信息

J Surg Res. 2019 Mar;235:148-159. doi: 10.1016/j.jss.2018.09.063. Epub 2018 Oct 26.

DOI:10.1016/j.jss.2018.09.063

PMID:30691788

Abstract

BACKGROUND

Diabetic patients are known to be at increased risk of postoperative complications after multiple types of surgery. However, conflicting evidence exists regarding the association between diabetes and wound complications in mastectomy and breast reconstruction. This study evaluates the impact of diabetes on surgical outcomes after mastectomy procedures and implant-based breast reconstruction.

METHODS

The American College of Surgeons National Surgical Quality Improvement Program database review from 2010 to 2015 identified patients undergoing total, partial, or subcutaneous mastectomy, as well as immediate or delayed implant reconstruction. Primary outcomes included postoperative wound complications and implant failure. Preoperative variables and outcomes were compared between diabetic and nondiabetic patients. Multivariate regression was used to control for confounders.

RESULTS

The following groups were identified: partial (n = 52,583), total (n = 41,540), and subcutaneous mastectomy (n = 3145), as well as immediate (n = 4663) and delayed (n = 4279) implant reconstruction. Diabetes was associated with higher rates of superficial incisional surgical site infection (SSI) in partial mastectomy (odds ratio [OR] = 8.66; P = 0.03). Diabetes was also associated with higher rates of deep incisional SSI (OR = 1.61; P = 0.01) in subcutaneous mastectomy and both superficial (OR = 1.56; P = 0.04) and deep incisional SSI (OR = 2.07; P = 0.04) in total mastectomy. Diabetes was not associated with any wound complications in immediate reconstruction but was associated with higher rates of superficial incisional SSI (OR = 17.46; P < 0.001) in the delayed reconstruction group. There was no association with implant failure in either group.

CONCLUSIONS

Evaluation of the largest national cohort of mastectomy and implant reconstructive procedures suggests that diabetic patients are at significantly increased risk of 30-d postoperative infectious wound complications but present no difference in rates of early implant failure.

摘要

背景

已知患有糖尿病的患者在接受多种类型手术后发生术后并发症的风险增加。然而，关于糖尿病与乳房切除术和乳房重建中的伤口并发症之间的关联存在相互矛盾的证据。本研究评估了糖尿病对乳房切除术和植入物乳房重建后手术结果的影响。

方法

从 2010 年至 2015 年，对美国外科医师学院国家外科质量改进计划数据库进行了回顾，确定了接受全乳切除术、部分切除术或皮下切除术以及即刻或延迟植入物重建的患者。主要结果包括术后伤口并发症和植入物失败。比较了糖尿病患者和非糖尿病患者的术前变量和结果。使用多元回归来控制混杂因素。

结果

确定了以下组：部分切除术（n=52583）、全切除术（n=41540）和皮下切除术（n=3145），以及即刻植入物重建（n=4663）和延迟植入物重建（n=4279）。糖尿病与部分乳房切除术的浅表切口手术部位感染（SSI）发生率较高相关（优势比[OR] = 8.66；P = 0.03）。糖尿病还与皮下乳房切除术中深部切口 SSI 发生率较高相关（OR = 1.61；P = 0.01），以及全乳房切除术中浅表（OR = 1.56；P = 0.04）和深部切口 SSI 发生率较高（OR = 2.07；P = 0.04）。糖尿病与即刻重建中任何伤口并发症无关，但与延迟重建组中浅表切口 SSI 发生率较高相关（OR = 17.46；P <0.001）。两组均与植入物失败无关。