Singh Devinder, Slavin Benjamin R, Holton Tripp
University of Miami Miller School of Medicine, Miami, Fla.
Anne Arundel Medical Center, Annapolis, Md.
Plast Reconstr Surg Glob Open. 2021 Jan 22;9(1):e3385. doi: 10.1097/GOX.0000000000003385. eCollection 2021 Jan.
TriNetX (TriNetX Inc., Cambridge, Mass.) is a federated electronic medical record network. The TriNetX system conducts customized search queries of over 36 million electronic medical records, and returns results in just minutes. To our group's knowledge, TriNetX has not been previously used in plastic surgery research. This study aimed to utilize a continuously updated federated network of 36,000,000 electronic medical records (TriNetX) for comparing 90-day postoperative outcomes between prosthetic breast reconstruction techniques.
Using TriNetX, we analyzed the records of approximately 36 million patients in 31 health care organizations. The de-identified records of 18,744,519 women (age 18-9) were retrospectively screened. A cohort of 4747 patients with a diagnosis of malignant neoplasm of the breast, any stage, having undergone mastectomy, and breast reconstruction with tissue expander was compared with a second cohort of 870 patients diagnosed with malignant neoplasm of the breast, any stage, mastectomy, and immediate insertion of breast implant following mastectomy. Surgical site occurrences occurring within 90 days postoperatively were compared using propensity score matching.
Propensity score matching resulted in 870 patients in both well-balanced cohorts. There were no statistically significant differences between the balanced cohorts with respect to 90-day surgical site occurrences.
TriNetX enables data-driven clinical research such as retrospective cohort comparison. During the 90-day postoperative period, there were fewer complications noted in the single-stage cohort for all outcomes studied; although this comparison was not statistically significant, we believe it demonstrates a clinically significant finding that single-stage direct-to-implant is at least as safe as the more complicated 2-stage approach.
TriNetX（TriNetX公司，马萨诸塞州剑桥）是一个联合电子病历网络。TriNetX系统对超过3600万份电子病历进行定制搜索查询，并在几分钟内返回结果。据我们团队所知，TriNetX此前尚未用于整形外科研究。本研究旨在利用一个不断更新的包含3600万份电子病历的联合网络（TriNetX），比较假体乳房重建技术之间的90天术后结果。
使用TriNetX，我们分析了31个医疗机构中约3600万名患者的记录。对18744519名年龄在18 - 9岁的女性的去标识化记录进行了回顾性筛查。将4747例诊断为任何分期的乳腺恶性肿瘤、接受了乳房切除术并使用组织扩张器进行乳房重建的患者队列，与第二组870例诊断为任何分期的乳腺恶性肿瘤、接受了乳房切除术并在乳房切除术后立即植入乳房假体的患者进行比较。使用倾向得分匹配法比较术后90天内发生的手术部位事件。
倾向得分匹配后，两个平衡队列中均有870例患者。在90天手术部位事件方面，平衡队列之间没有统计学上的显著差异。
TriNetX能够实现数据驱动的临床研究，如回顾性队列比较。在术后90天内，单阶段队列在所有研究结果中出现的并发症较少；尽管这种比较没有统计学意义，但我们认为这表明了一个具有临床意义的发现，即单阶段直接植入假体至少与更复杂的两阶段方法一样安全。
