Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
J Reconstr Microsurg. 2023 Nov;39(9):715-726. doi: 10.1055/a-2056-0729. Epub 2023 Mar 16.
Autologous free-flap breast reconstruction (ABR) is a valuable surgical option for patients following mastectomy. The coronavirus disease 2019 (COVID-19) pandemic has led to a myriad of factors that have affected access to care, hospital logistics, and postoperative outcomes. This study aims to identify differences in patient selection, hospital course and severity, and postoperative outcomes for patients who underwent ABR during and prior to the COVID-19 pandemic.
Patients undergoing ABR from the American College of Surgeons National Surgical Quality Improvement Program 2019 to 2020 database were analyzed to compare sociodemographics, hospital course, and outcomes over the first postoperative month. Multivariable logistic regression was used to identify factors predictive of complications based on the operative year.
In total, 3,770 breast free flaps were stratified into two groups based on the timing of reconstruction (prepandemic and pandemic groups). Patients with a diagnosis of disseminated cancer were significantly less likely to undergo ABR during the COVID-19 pandemic. On univariate analysis, there were no significant differences in postoperative complications between the two groups. When controlling for potentially confounding sociodemographic and clinical risk factors, the COVID-19 group was significantly more likely to undergo reoperation compared with the prepandemic group ( < 0.05).
When comparing outcomes for patients who underwent ABR prior to and during the COVID-19 pandemic, we found a significant increase in the odds of reoperation for those who had ABR during the pandemic. Debridement procedures and exploration for postoperative hemorrhage, thrombosis, or infection increased in the prepandemic group compared to the COVID-19 group. Notably, operative times decreased.
自体游离皮瓣乳房重建（ABR）是乳房切除术后患者的一种有价值的手术选择。 2019 年冠状病毒病（COVID-19）大流行导致了无数因素，这些因素影响了患者获得治疗的机会、医院后勤和术后结果。本研究旨在确定在 COVID-19 大流行期间和之前接受 ABR 的患者在患者选择、住院过程和严重程度以及术后结果方面的差异。
分析了美国外科医师学会国家手术质量改进计划 2019 年至 2020 年数据库中接受 ABR 的患者，以比较术后第一个月的社会人口统计学、住院过程和结果。多变量逻辑回归用于根据手术年份确定并发症的预测因素。
总共对 3770 例乳房游离皮瓣进行了分层，根据重建时间（大流行前和大流行组）分为两组。患有转移性癌症的患者在 COVID-19 大流行期间接受 ABR 的可能性显著降低。在单变量分析中，两组之间术后并发症无显著差异。在控制潜在混杂的社会人口统计学和临床危险因素后，与大流行前组相比，COVID-19 组更有可能进行再次手术（<0.05）。
在比较 COVID-19 大流行前后接受 ABR 的患者的结果时，我们发现大流行期间接受 ABR 的患者再次手术的几率显著增加。与 COVID-19 组相比，大流行前组的清创术和探查术后出血、血栓形成或感染的次数增加。值得注意的是，手术时间减少了。
