Marxen Troy, Shauly Orr, Losken Albert
Department of Medical Education, Emory University School of Medicine, Atlanta, Ga.
Division of Plastic and Reconstructive Surgery, Emory University School of Medicine, Atlanta, Ga.
Plast Reconstr Surg Glob Open. 2022 Jul 20;10(7):e4448. doi: 10.1097/GOX.0000000000004448. eCollection 2022 Jul.
Implant-based breast reconstruction can be accomplished in a variety of ways and can result in vastly different postoperative experiences for patients. The COVID-19 pandemic and recent trends have resulted in a shift toward outpatient management of these patients.
A systematic review of PubMed and Embase databases was conducted. A total of 1328 articles were identified on initial search, and after several rounds of review, a total of four met inclusion and exclusion criteria. Manuscripts were included if postmastectomy alloplastic breast reconstruction was performed, and there was documentation of same-day discharge. This cohort of patients was compared with traditional, planned overnight admission cohorts found in the literature. Objective data compared between groups included preoperative patient factors and postoperative complication rates.
Four studies representing data on a total of 574 patients were included: 289 were same-day discharge and 285 were overnight admission. Patient characteristics of body mass index, radiation, smoking, and bilateral procedures were comparable. Tissue expanders were used more frequently than implants in both cohorts. The rate of overall complications was 33% for same-day discharge and 34% for overnight admission. Rates of major and minor complications, including infection, seroma, and hematoma, were similar. There was no increase in reoperations or readmissions reported in any of the studies.
Same-day discharge after mastectomy with immediate alloplastic reconstruction is a safe approach to treatment in both the ambulatory and hospital setting. There are comparable rates of common complications such as infection, seroma, and hematoma, with no increase in readmission or reoperation.
基于植入物的乳房重建可以通过多种方式完成，并且会给患者带来截然不同的术后体验。新冠疫情及近期趋势已导致这些患者的管理模式向门诊治疗转变。
对PubMed和Embase数据库进行了系统综述。初步检索共识别出1328篇文章，经过几轮评审后，共有4篇符合纳入和排除标准。若进行了乳房切除术后异体乳房重建且有当日出院记录，则纳入手稿。将这组患者与文献中传统的计划性过夜住院患者组进行比较。组间比较的客观数据包括术前患者因素和术后并发症发生率。
纳入了4项研究，共代表574例患者的数据：289例为当日出院，285例为过夜住院。两组患者的体重指数、放疗史、吸烟情况和双侧手术等特征具有可比性。两组中组织扩张器的使用频率均高于植入物。当日出院组的总体并发症发生率为33%，过夜住院组为34%。包括感染、血清肿和血肿在内的主要和次要并发症发生率相似。所有研究均未报告再次手术或再次入院率增加。
乳房切除术后即刻进行异体重建并当日出院，在门诊和医院环境中都是一种安全的治疗方法。感染、血清肿和血肿等常见并发症的发生率相当，再次入院或再次手术率没有增加。
