低容量社区医院在未接受微血管 fellowship 培训情况下进行腹壁下动脉穿支乳房重建术后的手术及患者报告结局
Surgical and Patient Reported Outcomes After DIEP Breast Reconstruction at a Low-Volume Community Hospital Without Microvascular Fellowship Training.
作者信息
Kao Kenneth K, Nishikawa Scott M, Faringer Paul D
机构信息
Department of Plastic Surgery, Kaiser Permanente Moanalua Medical Center; Honolulu, HI.
出版信息
Eplasty. 2021 Sep 29;21:e9. eCollection 2021.
BACKGROUND
Microsurgical breast reconstruction is typically performed at large, academic centers by fellowship-trained surgeons. This study examines surgical and patient-reported outcomes (PROs) after deep inferior epigastric perforator (DIEP) flap breast reconstruction at a community hospital by surgeons without fellowship training.
METHODS
A prospective clinical database and BREAST-Q results were obtained from 33 patients after 45 DIEP flaps performed between 2016 and 2020. PROs and complications were compared to normative data and multi-institutional series. Regression analysis of patient and surgical factors with BREAST-Q scores was performed.
RESULTS
Thirty-one patients completed BREAST-Q (response rate = 94%). Overall flap survival was 97.8%. Complications were not statistically different from larger published series ( > 0.05). Patients reported excellent outcomes after breast reconstruction: satisfaction with breasts (80.6 ± 4.3), satisfaction with outcome (88.3 ±17.7), psychosocial well-being (80.74 ± 17.4), sexual well-being (68.2 ± 24.1), physical well-being - chest (73.8 ± 16.1), and physical well-being - abdomen (73.3 ± 17.4). PROs were not statistically different from published multicenter data with the exception of superior scores in sexual well-being ( < 0.05) and breast satisfaction ( < 0.0001). Satisfaction with outcome varied by patient age and was 20.7 points higher for patients over 55 compared to patients 46 to 55 years of age ( < 0.05). Satisfaction with breasts was 29 points lower after total flap loss ( < 0.005). Psychosocial well-being scores were 26.98 points lower after a takeback ( < 0.05). Sexual well-being and physical well-being - chest scores were negatively related to increasing body mass index (BMI) ( < 0.05).
CONCLUSION
DIEP flap breast reconstruction can be performed with high quality and excellent PROs at a community hospital by surgeons without microvascular fellowship training.
背景
显微外科乳房重建通常由接受过专项培训的外科医生在大型学术中心进行。本研究调查了在社区医院由未接受专项培训的外科医生进行腹壁下深动脉穿支（DIEP）皮瓣乳房重建后的手术结果及患者报告结局（PRO）。
方法
获取了2016年至2020年间33例患者接受45次DIEP皮瓣手术后的前瞻性临床数据库及BREAST-Q结果。将PRO和并发症与标准数据及多机构系列进行比较。对患者及手术因素与BREAST-Q评分进行回归分析。
结果
31例患者完成了BREAST-Q调查（回复率=94%）。皮瓣总体存活率为97.8%。并发症与已发表的更大系列研究无统计学差异（>0.05）。患者报告乳房重建后结局良好：对乳房的满意度（80.6±4.3）、对结局的满意度（88.3±17.7）、心理社会幸福感（80.74±17.4）、性幸福感（68.2±24.1）、胸部身体幸福感（73.8±16.1）以及腹部身体幸福感（73.3±17.4）。除性幸福感（<0.05）和乳房满意度（<0.0001）得分较高外，PRO与已发表的多中心数据无统计学差异。对结局的满意度因患者年龄而异，55岁以上患者比46至55岁患者高20.7分（<0.05）。皮瓣完全坏死的患者对乳房的满意度低29分（<0.005）。回植后心理社会幸福感得分低26.98分（<0.05）。性幸福感和胸部身体幸福感得分与体重指数（BMI）增加呈负相关（<0.05）。
结论
在社区医院，未接受微血管专项培训的外科医生也能高质量地进行DIEP皮瓣乳房重建，并取得良好的PRO。
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