Division of Surgery & Interventional Science, University College London, London, United Kingdom.
Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, United Kingdom.
J Plast Reconstr Aesthet Surg. 2023 Dec;87:180-186. doi: 10.1016/j.bjps.2023.07.048. Epub 2023 Jul 26.
Currently, one published study documented operative time (OT) as a predictor for postoperative outcomes in bilateral deep inferior epigastric perforator (DIEP) flap breast reconstructions. No literature has investigated this in unilateral DIEP flaps. We aimed to determine the relationship between unilateral OT, postoperative complications, unplanned reoperations (UR), and extended length-of-stay (eLOS).
Patients who underwent elective unilateral DIEP reconstruction from 2018 to 2023 at a tertiary centre in London, United Kingdom, were retrospectively analysed. Patients were divided into four groups depending on OT quartiles to define a critical cut-off period. Data on extensive covariates, including procedural complexity, was recorded and used in univariable and multivariable regression models.
The final cohort contained 173 patients. After risk-adjustment, ≥421-minute operations led to a significantly higher overall complication rate (HR: 2.14, 95% CI: 1.26, 3.64, p = 0.005) relative to <421 min. Significantly higher odds of eLOS were observed in the ≥460-minute group (OR: 2.07, 95% CI: 1.07, 3.99, p = 0.03) compared to <460 min. There was no significant effect on the rate of postoperative UR across any OT group.
We confirmed OT was an independent predictor for postoperative outcomes in the DIEP flap, and demonstrated this in unilateral reconstructions. A clinical maximum threshold of 7 h was derived based on this cohort to help guide future surgical practice. Efficiency can be achieved by meticulous preoperative planning and process standardisation, multiple senior surgeons working per flap, and smooth teamwork between specialities and intraoperative staff.
目前，已有一项已发表的研究将手术时间（OT）记录为双侧腹壁下动脉穿支皮瓣（DIEP）乳房重建术后结果的预测因素。但尚无文献研究单侧 DIEP 皮瓣的情况。我们旨在确定单侧 DIEP 皮瓣 OT 与术后并发症、计划外再次手术（UR）和延长住院时间（eLOS）之间的关系。
对英国伦敦一家三级中心 2018 年至 2023 年期间行择期单侧 DIEP 重建的患者进行回顾性分析。根据 OT 四分位数将患者分为四组，以确定关键的截止时间。记录包括手术复杂性在内的广泛协变量的数据，并用于单变量和多变量回归模型。
最终队列包含 173 名患者。经过风险调整后，≥421 分钟的手术与<421 分钟的手术相比，总并发症发生率显著更高（HR：2.14，95%CI：1.26，3.64，p=0.005）。≥460 分钟组的 eLOS 更高（OR：2.07，95%CI：1.07，3.99，p=0.03），而<460 分钟组的 eLOS 更高。在任何 OT 组中，UR 发生率均无显著影响。
我们证实 OT 是 DIEP 皮瓣术后结果的独立预测因素，并在单侧重建中证明了这一点。根据本队列得出的临床最大阈值为 7 小时，有助于指导未来的手术实践。通过术前精心规划和流程标准化、每皮瓣由多位高级外科医生操作以及各专业和术中人员之间的顺畅协作，可以实现效率。
