Rowley Mallory A, Thawanyarat Kometh, Shah Jennifer K, Cai Lawrence, Turner Elizabeth, Manrique Oscar J, Thornton Brian, Nazerali Rahim
Upstate Medical University, State University of New York, Syracuse, NY, USA.
AU/UGA Medical Partnership, Medical College of Georgia at Augusta University, Athens, GA, USA.
Aesthet Surg J Open Forum. 2022 May 7;4:ojac039. doi: 10.1093/asjof/ojac039. eCollection 2022.
The surgical literature debates about whether an average intraoperative fractional inspired level of oxygen (FiO) greater than 80% confers lower postsurgical complication rates. Although some evidence demonstrates minimal or no difference in short-term mortality or surgical site infections, few studies suggest negative long-term outcomes.
To the best of our knowledge, this is the first study examining the relationship between intraoperative FiO levels and postoperative outcomes in the setting of immediate prepectoral implant-based breast reconstruction.
The authors retrospectively reviewed the complication profiles of 309 patients who underwent prepectoral 2-stage breast reconstruction following mastectomy between 2018 and 2021 at a single institution. Two cohorts were created based on whether intraoperative FiO was greater than 80% or less than or equal to 80%. Complication rates between the cohorts were analyzed using Chi-squared test, Fisher's exact test, and multivariable logistic regressions. Variables examined included demographic information; smoking history; preexisting comorbidities; history of chemotherapy, radiation, or axillary lymph node dissection; and perioperative information.
Chi-squared and multivariable regression analysis demonstrated no significant difference between cohorts in complication rates other than reoperation. Reoperation rates were significantly increased in the FiO greater than 80% cohort ( = 0.018). Multivariable logistic regression also demonstrated that the use of acellular dermal matrix was significantly associated with increased postoperative complications (odds ratio 11.985; = 0.034).
Complication rates did not statistically differ in patients with varying intraoperative FiO levels outside of reoperation rates. In the setting of implant-based prepectoral breast reconstruction, hyperoxygenation likely does not lead to improved postsurgical outcomes.
外科文献中存在关于术中平均吸入氧分数（FiO）大于80%是否能降低术后并发症发生率的争论。尽管一些证据表明在短期死亡率或手术部位感染方面差异极小或无差异，但很少有研究提示存在负面的长期结果。
据我们所知，这是第一项研究即刻乳房切除术后基于胸前植入物乳房重建术中FiO水平与术后结果之间关系的研究。
作者回顾性分析了2018年至2021年在单一机构接受乳房切除术后两阶段胸前乳房重建的309例患者的并发症情况。根据术中FiO是否大于80%或小于或等于80%创建了两个队列。使用卡方检验、费舍尔精确检验和多变量逻辑回归分析队列之间的并发症发生率。所检查的变量包括人口统计学信息；吸烟史；既往合并症；化疗、放疗或腋窝淋巴结清扫史；以及围手术期信息。
卡方检验和多变量回归分析表明，除再次手术外，队列之间在并发症发生率方面无显著差异。FiO大于80%的队列中再次手术率显著增加（P = 0.018）。多变量逻辑回归还表明，使用脱细胞真皮基质与术后并发症增加显著相关（比值比11.985；P = 0.034）。
除再次手术率外，不同术中FiO水平患者的并发症发生率在统计学上无差异。在基于植入物的胸前乳房重建中，高氧状态可能不会导致更好的术后结果。
