Martin Shanique, Turner Elizabeth, Nguyen Alan, Thornton Brian, Nazerali Rahim S
From the Stanford University School of Medicine, Stanford, CA.
ThorntonMD Plastic Surgery, Louisville, KY.
Ann Plast Surg. 2020 May;84(5S Suppl 4):S318-S322. doi: 10.1097/SAP.0000000000002320.
Individualized postsurgical risk assessment models provide surgeons and patients with information that is vital to the surgical decision-making process. One such tool, the Breast Reconstruction Risk Assessment (BRA) score, uses a limited selection of patient-specific factors to predict 30-day postsurgical risk of surgical site infection, seroma, dehiscence, reoperation and explantation associated with immediate submuscular tissue expander breast reconstruction. This model's performance in prepectoral tissue expander reconstruction has not been previously reported. Here, we evaluate the performance of the BRA score model in a population of patients who underwent immediate prepectoral tissue expander breast reconstruction.
A retrospective chart review was conducted of prepectoral breast reconstructions performed in 2 institutions between January 2017 and December 2018. Complications occurring within 30 days postoperatively were documented and compared with the BRA score predicted risk for each patient.
Overall 247 patients (average age, 49.2 years) were included in the study. The mean BRA score predicted 30-day risk of a complication was 13.0% (7.5-41.5%). The observed rate of 30-day postoperative complications was 31.2% (77 patients), though only 36 (14.6%) patients had complications included in the model. The remaining patients experienced skin necrosis or hematoma as their only early complication. The 30-day BRA score model demonstrated good fit for the overall occurrence of any of the BRA score predicted complications (Hosmer-Lemeshow 0.7167), though the model discrimination was poor (C statistic <0.60). Notably, half of the 30-day postsurgical complications observed in this study were due to skin necrosis, a complication not currently included in the 30-day BRA score model.
Our results indicate that the current 30-day BRA score model may have poor predictive value in prepectoral breast reconstruction. The most common early complication observed, skin necrosis, is not currently included in the model, suggesting that caution should be applied when using this risk predictive calculator as an adjunct to patient evaluation and counseling.
个体化的术后风险评估模型为外科医生和患者提供了对手术决策过程至关重要的信息。一种这样的工具，即乳房重建风险评估（BRA）评分，使用有限的特定患者因素来预测与即刻肌下组织扩张器乳房重建相关的手术部位感染、血清肿、伤口裂开、再次手术和植入物取出的30天术后风险。该模型在胸前组织扩张器重建中的表现此前尚未见报道。在此，我们评估BRA评分模型在接受即刻胸前组织扩张器乳房重建的患者群体中的表现。
对2017年1月至2018年12月期间在2家机构进行的胸前乳房重建进行回顾性病历审查。记录术后30天内发生的并发症，并与每个患者的BRA评分预测风险进行比较。
本研究共纳入247例患者（平均年龄49.2岁）。BRA评分预测的30天并发症平均风险为13.0%（7.5 - 41.5%）。观察到的术后30天并发症发生率为31.2%（77例患者），不过只有36例（14.6%）患者出现了模型中包含的并发症。其余患者仅出现皮肤坏死或血肿作为早期并发症。30天BRA评分模型对BRA评分预测的任何并发症的总体发生情况显示出良好的拟合度（Hosmer-Lemeshow检验值为0.7167），不过模型的区分度较差（C统计量<0.60）。值得注意的是，本研究中观察到的30天术后并发症中有一半是由于皮肤坏死，这是一种目前未包含在30天BRA评分模型中的并发症。
我们的结果表明，当前的30天BRA评分模型在胸前乳房重建中可能具有较差的预测价值。观察到的最常见早期并发症，即皮肤坏死，目前未包含在模型中，这表明在将这种风险预测计算器用作患者评估和咨询的辅助工具时应谨慎使用。
