Rich Matthew D, Sorenson Thomas J, Lamba Abhinav, Hillard Christopher, Mahajan Ashish
aDivision of Plastic Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
bMedical School, University of Minnesota, Minneapolis, Minnesota, USA.
Breast Care (Basel). 2022 Oct;17(5):495-500. doi: 10.1159/000524638. Epub 2022 Apr 21.
There are no data describing the need for preoperative nutritional optimization in patients undergoing breast reconstruction surgery. The purpose of this research was to identify if preoperative breast reconstruction patients are grossly nutritionally deficient as defined by preoperative serum albumin and, thus, if routine preoperative nutrition screening and optimization is necessary in this patient population.
Adult patients who underwent breast reconstruction surgery between 2015 and 2019 were identified within the National Safety and Quality Improvement Program database. Variables of interest for this group of patients were collected, and comparisons were made for these variables between three different breast reconstruction modalities (implant-based reconstruction [IBR], expander-based reconstruction [EBR], and free tissue-based reconstruction [FTBR]) with χ and ANOVA statistical tests.
A total of 14,509 patients were included. There was not a significant difference in preoperative serum albumin measurements between the three reconstruction modalities and mean measurements for the three reconstruction modalities were all within normal limits. Secondarily, when comparing groups, FTBR had higher incidence of superficial surgical site infection (SSI) (4.49% vs. 1.6% vs. 1.56%, respectively; < 0.00001), deep SSI (1.57% vs. 0.48% vs. 0.94%, respectively; < 0.00001), and wound disruption (2.16% vs. 0.78% vs. 0.94%, respectively; < 0.00001) than IBR and EBR.
Preoperative nutritional status was found to be grossly appropriate in a large population of breast reconstruction patients. Furthermore, the ordering of routine preoperative serum albumin is unnecessary and represents an extraneous healthcare cost that does not lead to improved outcomes in breast reconstruction. FTBR incurred the greatest risk of surgical complication independent of preoperative nutritional status.
目前尚无关于接受乳房重建手术患者术前营养优化需求的数据。本研究的目的是确定术前乳房重建患者是否如术前血清白蛋白所定义的那样存在严重营养缺乏，从而确定该患者群体是否需要进行常规术前营养筛查和优化。
在国家安全与质量改进计划数据库中识别出2015年至2019年间接受乳房重建手术的成年患者。收集该组患者的相关变量，并使用χ检验和方差分析统计检验对三种不同乳房重建方式（植入物乳房重建[IBR]、扩张器乳房重建[EBR]和游离组织乳房重建[FTBR]）的这些变量进行比较。
共纳入14509例患者。三种重建方式之间术前血清白蛋白测量值无显著差异，三种重建方式的平均测量值均在正常范围内。其次，在比较各组时，FTBR的浅表手术部位感染（SSI）发生率（分别为4.49%、1.6%和1.56%；P<0.00001）、深部SSI发生率（分别为1.57%、0.48%和0.94%；P<0.00001）和伤口裂开发生率（分别为2.16%、0.78%和0.94%；P<0.00001）均高于IBR和EBR。
在大量乳房重建患者中，术前营养状况总体上是合适的。此外，常规术前检测血清白蛋白没有必要，这是一项额外的医疗费用，并不会改善乳房重建的效果。FTBR发生手术并发症的风险最高，且与术前营养状况无关。
