From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University.
Plast Reconstr Surg. 2023 Jul 1;152(1):1e-11e. doi: 10.1097/PRS.0000000000010156. Epub 2023 Jan 2.
Coronavirus disease of 2019 (COVID-19) poses unique challenges for breast reconstruction. At the authors' institution, COVID-19 postoperative protocols mandated patients undergoing immediate prosthetic breast reconstruction transition from 23-hour postoperative observation to same-day discharge. The authors sought to compare complications and hospital costs between these groups.
A retrospective study of consecutive patients who underwent immediate prosthetic breast reconstruction from March of 2019 to April of 2021 at an academic hospital was performed. Before mid-March of 2020, patients were admitted postoperatively for observation; after mid-March of 2020, patients were discharged the same day. Postoperative complications at 48 hours, 30 days, and 90 days and hospital costs were compared.
There were 238 patients included (119 outpatient and 119 observation). Across all time points, total complications, major complications, categorical complications (wound healing, seroma, hematoma, infection, implant exposure), and reconstructive failures were low and not statistically different between groups. There were no differences in 30-day hospital readmission/reoperation rates (7.6% outpatient versus 9.2% observation; P = 0.640). No patient or surgical factors predicted major complication or hematoma by 48 hours or infection by 90 days. At 90 days, radiation history ( P = 0.002) and smoking ( P < 0.001) were significant predictors of major complications. Average patient care costs outside of surgery-specific costs were significantly lower for outpatients ($1509 versus $4045; P < 0.001).
Complications after immediate prosthetic breast reconstruction are low. Outpatient surgery is safe, harboring no increased risk of complications. Furthermore, outpatient care is more cost-effective. Therefore, surgeons should consider outpatient management of these patients to minimize COVID-19 exposure and reduce resource consumption, all while maintaining excellent surgical care.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
2019 年冠状病毒病（COVID-19）给乳房重建带来了独特的挑战。在作者所在机构，COVID-19 术后方案要求接受即刻假体乳房重建的患者从术后 23 小时观察转为当天出院。作者旨在比较两组之间的并发症和住院费用。
对 2019 年 3 月至 2021 年 4 月在一家学术医院接受即刻假体乳房重建的连续患者进行了回顾性研究。在 2020 年 3 月中旬之前，患者术后住院观察；2020 年 3 月中旬之后，患者当天出院。比较术后 48 小时、30 天和 90 天的并发症和住院费用。
共纳入 238 例患者（门诊患者 119 例，观察患者 119 例）。在所有时间点，两组的总并发症、主要并发症、分类并发症（伤口愈合、血清肿、血肿、感染、假体暴露）和重建失败的发生率均较低，且无统计学差异。30 天内再次住院/再次手术率无差异（门诊患者为 7.6%，观察患者为 9.2%；P = 0.640）。术后 48 小时无患者或手术因素预测主要并发症或血肿，术后 90 天无患者或手术因素预测感染。90 天时，放射治疗史（P = 0.002）和吸烟史（P < 0.001）是主要并发症的显著预测因素。门诊患者的手术外患者护理费用明显低于观察患者（1509 美元比 4045 美元；P < 0.001）。
即刻假体乳房重建后的并发症发生率较低。门诊手术安全，无并发症风险增加。此外，门诊护理更具成本效益。因此，外科医生应考虑对这些患者进行门诊管理，以尽量减少 COVID-19 的暴露并减少资源消耗，同时保持卓越的手术护理。
临床问题/证据水平：治疗性，III 级。
