Bouhadana Gabriel, Safran Tyler, Al-Halabi Becher, Davison Peter G
Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
Division of Plastic and Reconstructive Surgery, McGill University, Montreal, Quebec, Canada.
Plast Reconstr Surg Glob Open. 2020 Apr 27;8(4):e2786. doi: 10.1097/GOX.0000000000002786. eCollection 2020 Apr.
Decision analysis allows clinicians to compare different strategies in the context of uncertainty, through explicit and quantitative measures such as quality of life outcomes and costing data. This is especially important in breast reconstruction, where multiple strategies can be offered to patients. This systematic review aims to appraise and review the different decision analytic models used in breast reconstruction.
A search of English articles in PubMed, Ovid, and Embase databases was performed. All articles regardless of date of publishing were considered. Two reviewers independently assessed each article, based on strict inclusion criteria.
Out of 442 articles identified, 27 fit within the inclusion criteria. These were then grouped according to aspects of breast reconstruction, with implant-based reconstruction (n = 13) being the most commonly reported. Decision analysis (n = 19) and/or economic analyses (n = 27) were employed to discuss reconstructive options. The most common outcome was cost (n = 27). The decision analysis models compared and contrasted surgical strategies, management options, and novel adjuncts.
Decision analysis in breast reconstruction is growing exponentially.The most common model used was a simple decision tree. Models published were of high quality but could be improved with a more in-depth sensitivity analysis. It is essential for surgeons to familiarize themselves with the concept of decision analysis to better tackle complicated decisions, due to its intrinsic advantage of being able to weigh risks and benefits of multiple strategies while using probabilistic models.
决策分析使临床医生能够在不确定性的背景下，通过生活质量结果和成本数据等明确的定量指标，比较不同的策略。这在乳房重建中尤为重要，因为可以为患者提供多种策略。本系统评价旨在评估和综述乳房重建中使用的不同决策分析模型。
在PubMed、Ovid和Embase数据库中检索英文文章。所有文章，无论发表日期，均被纳入考虑。两名评审员根据严格的纳入标准独立评估每篇文章。
在识别出的442篇文章中，27篇符合纳入标准。然后根据乳房重建的方面进行分组，其中基于植入物的重建（n = 13）是最常报道的。采用决策分析（n = 19）和/或经济分析（n = 27）来讨论重建方案。最常见的结果是成本（n = 27）。决策分析模型比较并对比了手术策略、管理选项和新型辅助手段。
乳房重建中的决策分析正在呈指数级增长。最常用的模型是简单决策树。已发表的模型质量较高，但通过更深入的敏感性分析可以进一步改进。由于决策分析具有能够在使用概率模型时权衡多种策略的风险和益处这一内在优势，外科医生熟悉决策分析的概念对于更好地处理复杂决策至关重要。
