自体乳房重建中住院时间的关键评估：国家手术质量改进计划分析。
A Critical Examination of Length of Stay in Autologous Breast Reconstruction: A National Surgical Quality Improvement Program Analysis.
机构信息
From George Washington University School of Medicine and Health Sciences; and the Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital; and the Department of Surgery, George Washington University Hospital.
出版信息
Plast Reconstr Surg. 2021 Jan 1;147(1):24-33. doi: 10.1097/PRS.0000000000007420.
BACKGROUND
This study aims to use the National Surgical Quality Improvement Program database to identify factors associated with extended postoperative length of stay after breast reconstruction with free tissue transfer.
METHODS
Consecutive cases of breast reconstruction with free tissue transfer were retrieved from the National Surgical Quality Improvement Program (2005 to 2017) database using CPT code 19364. Extended length of stay (dependent variable) was defined as greater than 5 days.
RESULTS
Nine thousand six hundred eighty-six cases were analyzed; extended length of stay was noted in 34 percent. On regression, patient factors independently associated with extended length of stay were body mass index (OR, 1.5; 95 percent CI, 1.2 to 1.9; p < 0.001), diabetes (OR, 1.3; 95 percent CI, 1.1 to 1.6; p = 0.003), and malignancy history (OR, 1.9; 95 percent CI, 1.22 to 3.02; p = 0.005). Operation time greater than 500 minutes (OR, 3; 95 percent CI, 2.73 to 3.28; p < 0.001) and immediate postmastectomy reconstruction (OR, 1.7; 95 percent CI, 1.16 to 2.48; p < 0.001) conferred risk for extended length of stay. Bilateral free tissue transfer was not significant. Operations performed in 2017 were at lower risk (OR, 0.2; 95 percent CI, 0.06 to 0.81; p = 0.02) for extended length of stay. Reoperation is more likely following operative transfusion and bilateral free tissue transfers, but less likely following concurrent alloplasty. Given a known operation time (minutes), postoperative length of stay (days) can be calculated using the following equation: length of stay = 2.559 + 0.003 × operation time.
CONCLUSIONS
This study characterizes the risks for extended length of stay after free tissue transfer breast reconstruction using a prospective multicenter national database. The result of this study can be used to risk-stratify patients during surgical planning to optimize perioperative decision-making.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
背景
本研究旨在利用国家外科质量改进计划数据库，确定与游离组织转移乳房重建术后延长住院时间相关的因素。
方法
使用 CPT 代码 19364 从国家外科质量改进计划（2005 年至 2017 年）数据库中检索连续的游离组织转移乳房重建病例。延长住院时间（因变量）定义为超过 5 天。
结果
共分析了 9686 例病例，34%的患者存在延长住院时间。回归分析显示，与延长住院时间独立相关的患者因素有体重指数（OR，1.5；95%CI，1.2 至 1.9；p<0.001）、糖尿病（OR，1.3；95%CI，1.1 至 1.6；p=0.003）和恶性肿瘤病史（OR，1.9；95%CI，1.22 至 3.02；p=0.005）。手术时间大于 500 分钟（OR，3；95%CI，2.73 至 3.28；p<0.001）和即刻乳房切除术重建（OR，1.7；95%CI，1.16 至 2.48；p<0.001）增加了延长住院时间的风险。双侧游离组织转移无显著意义。2017 年进行的手术（OR，0.2；95%CI，0.06 至 0.81；p=0.02）发生延长住院时间的风险较低。手术输血和双侧游离组织转移后更有可能再次手术，但同期异体移植后再次手术的可能性较小。已知手术时间（分钟）后，可使用以下公式计算术后住院时间（天）：住院时间=2.559+0.003×手术时间。
结论
本研究使用前瞻性多中心国家数据库描述了游离组织转移乳房重建术后延长住院时间的风险。本研究的结果可用于手术规划期间对患者进行风险分层，以优化围手术期决策。
临床问题/证据水平：风险，III 级。
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