评估自体乳房重建术后焦虑与修复手术的关系。

Assessing the Relationship between Anxiety and Revision Surgery following Autologous Breast Reconstruction.

机构信息

From the Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center; and the Department of Biostatistics and Bioinformatics, Duke Cancer Institute.

出版信息

Plast Reconstr Surg. 2019 Jul;144(1):24-33. doi: 10.1097/PRS.0000000000005696.

DOI:10.1097/PRS.0000000000005696

PMID:31246794

Abstract

BACKGROUND

Revision procedures address contour irregularities and aesthetic concerns following autologous breast reconstruction. Mental health diagnoses are known to influence patient satisfaction with reconstruction. The authors aimed to identify oncologic, reconstructive, and demographic factors, including mental health diagnoses, associated with the number of revisions after autologous breast reconstruction.

METHODS

The medical records of all adult women undergoing abdominal free flap-based breast reconstruction at a major academic institution between 2011 and 2016 were reviewed. Multivariate logistic regression was used to identify factors associated with receipt of revisions. Negative binomial regression was used to identify characteristics associated with number of revisions received.

RESULTS

Of 272 patients identified, 55.2 percent received one revision, 23.2 percent received two revisions, and 10.3 percent received three or more revisions after autologous breast reconstruction (median, one; range, zero to five). After adjustment on multivariate analysis, anxiety (OR, 4.34; p = 0.016) and bilateral reconstruction (OR, 3.10; p = 0.017) were associated with receipt of any revisions; other oncologic and reconstructive factors including breast cancer stage, receipt of radiation therapy, and type or timing of free flap reconstruction were not associated with revisions. Using univariate negative binomial regression, anxiety (incidence rate ratio, 1.34; p = 0.006), Caucasian race (incidence rate ratio, 1.24; p = 0.02), and bilateral reconstruction (incidence rate ratio, 1.39; p = 0.04) were predictive of increased numbers of revisions received. After stepwise selection on multivariate analysis, anxiety remained the only significant predictor of increased numbers of revisions.

CONCLUSIONS

Preoperative anxiety significantly influences the number of revisions after autologous breast reconstruction. Further research is necessary to better understand the interplay among mental health, patient preference, and outcomes in breast reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

摘要

背景

自体乳房重建后，修复手术可解决外形不规则和美学问题。心理健康诊断已知会影响患者对重建的满意度。作者旨在确定与自体乳房重建后修复次数相关的肿瘤学、重建和人口统计学因素，包括心理健康诊断。

方法

回顾了 2011 年至 2016 年期间在一家主要学术机构接受腹部游离皮瓣乳房重建的所有成年女性的病历。使用多变量逻辑回归来确定与接受修复相关的因素。使用负二项回归来确定与接受修复次数相关的特征。

结果

在确定的 272 名患者中，55.2%接受了一次修复，23.2%接受了两次修复，10.3%接受了三次或更多次自体乳房重建后修复（中位数为一次；范围为零至五次）。在多变量分析调整后，焦虑（OR，4.34；p = 0.016）和双侧重建（OR，3.10；p = 0.017）与接受任何修复相关；其他肿瘤学和重建因素，包括乳腺癌分期、放疗的接受情况以及游离皮瓣重建的类型或时间，与修复无关。使用单变量负二项回归，焦虑（发生率比，1.34；p = 0.006）、白种人（发生率比，1.24；p = 0.02）和双侧重建（发生率比，1.39；p = 0.04）与接受更多修复次数相关。在多变量分析的逐步选择后，焦虑仍然是接受更多修复次数的唯一显著预测因素。