From the Division of Plastic Surgery, Department of Surgery.
Mayo Clinic Alix School of Medicine.
Ann Plast Surg. 2020 Mar;84(3):271-275. doi: 10.1097/SAP.0000000000002051.
Implant-based breast reconstruction (IBR) accounts for 70% of postmastectomy reconstructions in the United States. Improving the quality of surgical care in IBR patients through accurate measurements of outcomes is necessary. The purpose of this study is to compare the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) data from our institution to our complete institutional health records database.
Data were collected and recorded for all patients undergoing IBR at our institution from 2015 to 2017. The data were completely identified and compared with our institutional NSQIP database for demographics and complications.
The electronic health records data search identified 768 IBR patients in 3 years and NSQIP reported on 229 (30%) patients. Demographics were reported similarly among the 2 databases. Rates of tissue expander/implant infections (5.9% vs 1.8%; P = 0.003) and wound dehiscence (3.5% vs 0.4%; P = 0.003) were not reported similarly between our database and NSQIP. However, the rates of hematoma (2.7% vs 1.8%) and skin flap necrosis (2.5% vs 1.8%) were comparable between the two databases. In our database, 43% of all complications presented after 30 days of surgery, beyond NSQIP's capture period.
Databases built on partial sampling, such as the NSQIP, may be useful for demographic analyses, but fall short of providing data for complications after IBR, such as infections and wound dehiscence. These results highlight the utility and importance of complete databases. National comparisons of clinical outcomes for IBR should be interpreted with caution when using partial databases.
在美国，植入物乳房重建（IBR）占乳房切除术后重建的 70%。通过准确测量结果来提高 IBR 患者的手术护理质量是必要的。本研究的目的是将我们机构的美国外科医师学会国家外科质量改进计划（NSQIP）数据与我们完整的机构健康记录数据库进行比较。
从 2015 年至 2017 年，我们机构对所有接受 IBR 的患者收集并记录数据。这些数据与我们机构的 NSQIP 数据库完全匹配，以比较患者的人口统计学和并发症。
电子健康记录数据搜索在 3 年内确定了 768 例 IBR 患者，而 NSQIP 报告了 229 例（30%）患者。这两个数据库报告的人口统计学数据相似。组织扩张器/植入物感染（5.9%比 1.8%；P=0.003）和伤口裂开（3.5%比 0.4%；P=0.003）的发生率在我们的数据库和 NSQIP 之间没有相似之处。然而，血肿（2.7%比 1.8%）和皮瓣坏死（2.5%比 1.8%）的发生率在这两个数据库中是可比的。在我们的数据库中，所有并发症中有 43%发生在手术后 30 天之后，超出了 NSQIP 的捕获期。
基于部分抽样的数据库，如 NSQIP，可能对人口统计学分析有用，但在 IBR 后的感染和伤口裂开等并发症方面的数据不足。这些结果突出了完整数据库的实用性和重要性。在使用部分数据库对 IBR 的临床结果进行国家比较时应谨慎解读。
